Departmental Assistant - Patient Benefit and Referral Specialist

UMass Amherst; Amherst (MA); On-site; USD 33,000 - 41,000; Part time

Job summary

University Health Services (UHS) at UMass Amherst is seeking a part-time Departmental Assistant to handle patient intake, eligibility verification, and data entry with accuracy. You will obtain pre-determinations and authorizations to ensure reimbursement and timely access to care.

You will also collect co-pays, reconcile daily logs, manage referrals, and support multiple departments while maintaining HIPAA compliance and excellent patient service.

Qualifications

• Associate degree or CMA certification required; alternative: high school diploma with 3+ years medical office experience.
• Experience with insurance verification, authorization and predetermination.
• Excellent oral and written communication, including telephone etiquette.
• Knowledge of insurance plans and ability to explain complex health plan details to patients.
• Proficiency with practice management and electronic health records (EHR).
• Strong customer service skills and ability to de-escalate front-line issues.

Responsibilities

• Interact with patients to collect and verify information during the intake process.
• Provide pre-determination of benefits and inform patients about responsibilities including co-pays.
• Address electronic eligibility alerts and contact patients when insurance is inactive.
• Collaborate with Billing and Coding for optimal reimbursement.
• Provide courteous, efficient service and maintain patient confidentiality per HIPAA.

Skills

Insurance verification

Authorization processes

EHR proficiency

Customer service

Telephone etiquette

Data entry

HIPAA compliance

Communication skills

Education

Associate Degree in Medical Assisting

Certified Medical Assistant

High school diploma + 3 years medical office experience

Tools

Microsoft Excel

Job description

Title: Departmental Assistant

Executive Area: Administration and Finance

College/School/MBU: Direct Medical Care

Department: UHS Ancillary Services

Work Location: Amherst

Schedule: Part Time

Work Arrangement: Onsite

Job Summary

Accurately performs all functions related to the patient intake process at University Health Services (UHS) by interviewing patients, verifying eligibility electronically via multi-payer systems and entering or updating information in the practice manager in a timely manner and with a high degree of accuracy. Ensures the facility will be reimbursed for the services performed by verifying eligibility and benefits and obtaining pre-determinations and authorizations. Assures timely access to care for patients. Collects co-pays and fee-for-service payments and prepares electronic reconciliation of daily log. Processes telephone traffic and urgent situations in a timely manner, supports and assists various departments, and utilizes the computer system to locate patients and providers. Verifies that all patients are complying with the UHS Eligibility policy.

Essential Functions

• Accurately performs all functions related to the patient intake process by interviewing patients, verifying eligibility electronically via multi-payer systems and entering or updating information in the practice manager in a timely manner and with a high degree of accuracy.
• Provides pre-determination of benefits and educates and informs patients about their responsibilities including co-pays and coordination of benefits.
• Addresses electronic eligibility alerts and contacts patients whose insurances are inactive with advance notice to be in compliance with the payer's timely filing requirements.
• Collaborates with the Billing and Coding Departments for maximizing reimbursement of services provided.
• Provides patients with courteous, friendly, fast and efficient services.
• Maintains and demonstrates current knowledge of commercial insurances and requirements of plans accepted at UHS.
• Tracks outgoing referrals for completion and compliance, compiles data and prepares reports on a monthly basis.
• Schedules and manages routine and walk-in appointments for a multidisciplinary practice, adhering to the guidelines set forth by the providers.
• Processes referrals and orders accordingly, to specialist groups or outside imaging facilities. Additional consideration is required for a high-tech imaging request prior to the scheduling of a patient appointment.
• Reviews patient insurance plans to determine whether or not authorization is necessary, and if so, obtains authorization from the patient's primary care provider or insurance company to facilitate patient care in-house and at specialist groups outside of UHS and receives proper reimbursement from the patient's insurance plan.
• Manages incoming phone calls for all aspects of medical care including but not limited to appointments, prescription refills, test results and messages to providers.
• Prepares documentation and information pertinent to the patient's appointment.
• Processes incoming referrals from outside primary care providers to allow patients to continue care at UHS while on campus. Reviews transaction codes to generate daily report to identify patients requiring an approval from their primary care provider. Contacts primary care provider and sends pertinent notes to obtain authorization, and once authorization is received, enters it into the practice manager for accurate reimbursement.
• Uses and manages systems to facilitate patient care at UHS, such as the Trext waiting system to alleviate patient wait times.
• Manages UHS Parkmobile system accurately to provide parking privileges to patients in the designated lot.
• Provides cross-coverage and back-up staffing support to other functions of the front-line staff, when needed.
• Maintains patient confidentiality at all times utilizing current HIPAA guidelines.
• Participates in annual UHS training and monthly departmental meetings to improve the quality of service provided to patients.

Other Functions

Performs other duties as assigned.

Minimum Qualifications

• Associate Degree from an accredited Medical Assistant Program or successful completion of certification as a Certified Medical Assistant, or high school diploma with at least 3 years of medical office experience.
• Prior experience with insurance verification, authorization and predetermination.
• Good oral and written communication skills including telephone etiquette.
• Knowledge of insurance plans; ability to understand and communicate detailed and complex health plan information to clientele.
• Practice management and electronic health record (EHR) proficiency.
• Excellent customer service skills and the ability to de-escalate front line customer service challenges.
• Ability to effectively communicate with colleagues, the public and other UHS staff.
• Strong computer, typing and oral communication skills, including telephone customer service skills.
• Experience working with Microsoft Excel or similar software.
• Working knowledge of basic hospital/clinic practice management and medical terminology.

Preferred Qualifications

• Experience in a multi-practice facility.

Additional Details

This position is subject to final budgetary and administrative approval.

Working Conditions

Work is performed in a standard office or indoor university environment and involves minimal physical exertion.

Working Schedule and Work Arrangement

20 hours per week; schedule varies based on departmental need.

Salary Information

Hourly Rate: $24 - $30