PAS Resource Specialist; Managed Care Coordinator and Surgery Scheduler

Department Overview

This position performs comprehensive managed care and surgery scheduling functions in support of multiple divisions within the Department of Otolaryngology. The role is responsible for ensuring patients are financially cleared and surgery coordination is completed while providing high-quality, patient-centered care.

Managed care duties include verifying insurance benefits; requesting, obtaining, and tracking authorizations for clinic appointments, surgeries, and diagnostic orders; and advocating with insurance companies on behalf of patients. This position collaborates closely with providers to compile appeal documentation and ensure payers receive complete and accurate information to process requests in a timely manner. The role is a service area expert on insurance requirements, communciates with patients regarding out of pocket charges and financial policies and maintains up-to-date knowledge of insurance plans in order to complete tasks efficiently.

Surgery scheduling requires a high level of coordination and follow-through to ensure all pre-surgical steps are completed. Responsibilities include initiating and tracking pre-operative testing, coordinating surgical clearances and medication management with outside specialists, and coordinating with medical representatives regarding specialized equipment and implants. Through proactive communication and careful oversight of each step, this position ensures patients are fully prepared, cleared, and set up to proceed safely with surgery.

This position provides backup clinic scheduling and front desk support for all divisions as needed. Requires the ability to navigate busy, multi-line phones and have strong problem‑solving and negotiation skills to manage complex scheduling situations while balancing patient needs and provider availability.

Functions as an integral member of the Department by contributing to new ideas for improving customer service and reducing costs. This position is expected to apply problem‑solving and negotiating skills in resolving provider, patient and insurance concerns. In addition, this position is expected to work independently as well as be an effective team member.

Serves as a liaison and information resource for physicians, nursing support staff, coworkers, IP admitting, perioperative services, insurance representatives and patients. Assist in other miscellaneous administrative tasks as needed within the Otolaryngology Department.

• This position will ensure patients have financial clearance prior to their appointment, diagnostic imaging, testing or surgery. This includes: verifying coverage and benefits, obtaining the necessary authorizations and benefit‑level exceptions, executing any necessary single‑case agreements, generating price estimates, providing cost information to patients so they understand their financial responsibility, executing any necessary Non‑Covered Charges Forms, OHP waivers, or Advance Beneficiary Notices and following and receiving approval for any necessary exceptions.
  
  Work with providers to compile appeal documents and ensure that insurance companies have all needed information in order to process our requests and updating information thoroughly in EPIC. This individual needs to maintain current information on all managed care insurance plan changes in order to utilize the information efficiently and effectively obtain authorizations.
• Surgery scheduling would support multiple divisions within the Otolaryngology Department and includes coordinating all appointments, pre‑surgical testing and imaging, medical clearance, medication management, transportation needs, special equipment and vendor/rep availability for each scheduled surgery. This requires a high level of coordination to ensure patients are fully prepared for surgery. Clinic scheduling tasks include answering a busy multi‑line phone, scheduling appointments, obtaining prior medical records and imaging and sending triages and in‑basket messages.
• Train new PAS on clinic scheduling functions and duties.
• Applies problem‑solving skills to resolve complex scheduling situations using negotiating…