Department Overview

The Referrals and Prices Estimates Systems Manager position is responsible for leading, directing, and implementing tactics for the Epic Managed Care Systems team which supports all of OHSU Health and its community connect partners. OHSU Health includes OHSU, Hillsboro Medical Center, Adventist Portland, and any future partners. The Epic Managed Care Systems team of Analysts, Senior Analysts, and Denials Coordinator play a highly important role in maintaining and operationalizing our Epic Referrals, AuthCert, and Price Estimate Applications, our connectivity and interfaces with any third-party vendors relating to these applications, completing root cause analysis and solution generation on denials, and providing technical analysis, design, build, implementation, training, and ongoing support for all workflows related to Managed Care activities. Managed Care activities include but are not limited to referrals, benefit verifications, prior authorizations, no authorization denials, patient estimates, real-time eligibility, No Surprise Billing requirements, and front-end cash collection workflows.

The Systems Manager is knowledgeable in Lean and/or process improvement methodologies so they can represent Managed Care both centralized and decentralized on related projects across the OHSU Health system. They work closely with Department Administrators, Directors, and Managers for centralized and non-centralized managed care initiatives, as well as the Enterprise Revenue Cycle teams to ensure positive outcomes. They are also expected to keep up to date on all Epic enhancements, functionality, and build as it relates to referrals, auth/cert, and price estimates to ensure the most efficient and effective workflows are being utilized.

This position serves as a liaison between Managed Care Coordinators, OHSU Managed Care Contracting Office, the ITG EPIC Teams, revenue cycle leadership, and 3rd Party Insurers.

Function/Duties of Position

Direct management and supervision of the Epic Managed Care Systems Team:

• Provides essential leadership direction pertinent to the operations of the department.
• Develops goals and objectives that promote a supportive and productive unit.
• Demonstrates cooperation, adaptability, flexibility, effective communication, and dependability in supporting team goals.
• Hires, motivates and coaches a department of individuals dedicated to driving excellence in the patient's financial experience.
• Ensures staff have adequate information and training to perform assigned tasks.
• Oversees issues that arise with personnel, referrals, price estimates, and organizational direction.
• Ensures all team members including themselves achieve and maintain all Epic certifications.
• Represents Managed Care both centralized and decentralized at key Patient Access meetings including but not limited to Managed Care Contracting Status Updates, New Business Assessment Team, the ITG Scheduling Meeting, and various project meetings as assigned.

Oversees system management and maintenance, analysis, design, and build:

• Participates and directs the system design, build, validation, implementation, and ongoing maintenance of the Epic Referral, Auth Cert, and Price Estimate applications and workflows.
• Works closely with the Centralized Managed Care Leadership team to develop standard referral and patient/referral work queue build and workflows for both the centralized and decentralized teams.
• Thoroughly documents and understands Managed Care business processes and how the Epic Referral, Auth Cert, and Prices Estimate application supports these processes.
• Works closely with all OHSU billing entities to develop a better understanding on how front-end staff can enhance the entire revenue cycle.
• Looks for operational efficiencies in collecting the necessary Managed Care components in a way that enhances the patient experience and produces the desired outcomes.
• Coordinates the department's referral authorization process toward the goal of all authorizations confirmed prior to an outpatient appointment or surgical procedure.
• Provides support and guidance regarding financial policies and compliance with federal/state rulings for self-pay and under-insured patients.
• Oversees, leads, and/or supports various projects that impact managed care workflows or the referral, auth cert, and/or prices estimate applications.
• Supports Epic go-live projects with OHSU and their partners.
• Coordinates with third-party payors to gain access to their websites for eligibility and benefit verification for all front-end access/Managed Care employees.

Oversees Referral, Auth Cert, and Price Estimate Workflow Training:

• Oversees the development and maintenance of the training modules for Authorization, No Surprise Billing, and Epic Estimates for OHSU Health and community connect partners.
• Independently facilitates a monthly meeting for all Managed Care Coordinators (MCC) to offer continuing education and support. Creates agendas, organizes payor presentations, and delivers educational materials.
• Provides instruction and guidance to practice staff for processes related to managed care.
• Presents educational sessions related to best practices and process improvements related to Managed Care.
• Serves as a liaison between the MCC group, Managed Care Contracting, and 3rd Party Insurers. Translates requirements from these groups into training for staff that is easy for the Managed Care Coordinators to understand.

Oversees Problem Resolution / Performance Excellence:

• Responses to customer problems.
• Troubleshoots Epic-related issues and operational barriers.
• Oversees the root cause analysis of denials and develops solutions to address root causes.
• Demonstrates self-motivation, takes on projects/tasks willingly, acts on opportunities to improve or gain knowledge, and constructively contributes new ideas.
• Communicates and documents problem progress and resolution.
• Analyzes problems to determine if it is necessary to resolve, and if needed, escalates to the appropriate key stakeholders.
• Communicates with Epic project leadership on the of trouble ticket resolutions to meet OHSU needs.
• When needed, works directly with Epic (Madison, WI based staff) on resolution of issues.
• Assists operational areas in the development of automated Epic workflows with the intention to reduce manual work and increase efficiencies.
• Analyzes and determines solutions to organizational and operational issues that promote and support Lean Processes.
• Participates in OPEx projects, specifically those related to Centralized and Non-Centralized Managed Care initiatives.

Other duties as assigned

Required Qualifications

• High school diploma plus one of the following:
  • Bachelor’s degree in healthcare administration or related degree OR
  • Equivalent combination of education and experience
  • Six years’ experience working in the healthcare with at least two years of managerial or project leadership experience
  • At least three years’ experience in a complex, multifaceted healthcare setting; experience should include exposure to ambulatory, in-patient, and surgery workflows related to revenue cycle, managed care, financial analysis and project management
• Epic Certification in Revenue Cycle application (Cadence, Prelude, ADT, or Resolute) within first year of employment.

Job Related Knowledge, Skills and Abilities (Competencies):

• Leadership skills to develop team concepts and consensus-building management style
• Able to supervise several people and multiple priorities in a highly complex environment
• Clear, effective verbal and written communication skills
• Ability to facilitate/manage projects independently utilizing project management principles and tools
• Ability to work in an autonomous environment and take initiative to do problem solving as required
• Strong desire to achieve outcomes in a timely manner
• Strong working knowledge of Excel, Word, Visio, and database programs
• Strong ability to analyze data to identify root causes and develop solutions to address them
• Superb organizational skills
• Strong customer service orientation and experience
• Strong ability to work autonomously, be flexible, and able to shift priorities on short notice
• Extensive knowledge of health care operations, including knowledge of HIPAA regulations

Preferred Qualifications

• Master’s Degree in Healthcare Administration or related.
• Specific experience with an integrated health record, Epic preferred. Epic certification in either Cadence, Prelude, ADT, or Resolute applications.
• A working knowledge of OHSU systems, policies and procedures.

Additional Details

Although the position is expected to work standard Monday – Friday business hours, there will be times when availability is necessary on weekends and during the evening.

All are welcome

Oregon Health & Science University values a diverse and culturally competent workforce. We are proud of our commitment to being an equal opportunity, affirmative action organization that does not discriminate against applicants on the basis of any protected class status, including disability status and protected veteran status. Individuals with diverse backgrounds and those who promote diversity and a culture of inclusion are encouraged to apply. To request reasonable accommodation contact the Affirmative Action and Equal Opportunity Department at 503-494-5148 or