Departmental Assistant - Patient and Referral Specialist

Apply now Job no: 528790
Work type: Hourly
Location: UMass Amherst
Department: Operations
Union: Non-Benefited
Categories: Temporary Non-Benefited

About UMass Amherst

The flagship of the Commonwealth, the University of Massachusetts Amherst is a nationally ranked public land-grant research university that seeks to expand educational access, fuel innovation and creativity, and share and use its knowledge for the common good. Founded in 1863, UMass Amherst sits on nearly 1,450-acres in scenic Western Massachusetts and boasts state-of-the-art facilities for teaching, research, scholarship, and creative activity.

The institution advances a diverse, equitable, and inclusive community where everyone feels connected and valued—and thrives, and offers a full range of undergraduate, graduate and professional degrees across 10 schools and colleges, and 100 undergraduate majors. We believe every member of our university community can contribute to our ongoing success by striving for the highest level of excellence as we seek breakthrough solutions to mounting environmental, social, economic, and technological challenges in our world.

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 update 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…