This role focuses primarily on coordination of efforts related to upstream CCO Quality Metrics. The position conducts internal and community-based project management and engagement to advance healthcare transformation with a focus on the assigned CCO region(s).
The Authorization Specialist is responsible for obtaining authorizations for surgical procedures, diagnostic testing, medications, DME, outgoing referrals, and other services as part of the daily operations of the Revenue Cycle Department.
Accountable to lead, develop, and maintain strong, positive relationships with assigned standard provider accounts, including assurance of provider satisfaction with PacificSource.
Responsibilities include administrative duties as well as other complex assignments such as maintaining company organizational charts, coordinating the learning management system, creating forms and keeping the VP of HR up to date on office activities/issues.
This position follows established policies and procedures to process a multitude of transactions for Government line of business
Support all aspects of the Grievance and Appeals (G&A) compliance program for Medicare, and Medicaid lines of business. Assume the primary role of interfacing with the Compliance department, Auditors, Vendors and G&A staff for purposes of monitoring and ensuring compliant operations.
The Enrollment Specialist is the primary point of contact for Mosaic patients with insurance applications and eligibility requirements with state and/or federal insurance programs, including Oregon Health Plan.
Provide clerical assistance to Appeals and Grievance team in entry and maintenance of case records. Provide high quality customer service to internal and external customers regarding appeals and grievance inquiries. Support member and ensure customer satisfaction.
Provides a wide range of support to Provider Network, Facets Business Support, Claims, Finance and Analytics in coding, hospital charge master tracking and evaluation, reimbursement methodology research, loading and documentation for all lines of business.
The Qualification Specialist ensures that medical documentation is accurate and gathered in an efficient and timely manner for all orders.
