About UMass Amherst
UMass Amherst, the Commonwealth's flagship campus, is a nationally ranked public research university offering a full range of undergraduate, graduate and professional degrees. The University sits on nearly 1,450-acres in the scenic Pioneer Valley of Western Massachusetts, and offers a rich cultural environment in a bucolic setting close to major urban centers. In addition, the University is part of the Five Colleges (including Amherst College, Hampshire College, Mount Holyoke College, and Smith College), which adds to the intellectual energy of the region.
Interprets and analyzes medical Explanation of Benefits (EOB) from third party payers and aged trial balance reports. Reconciles accounts by line adjustments and expenditure of funds. Assumes provider advocacy role interacting with insurance company personnel to resolve account discrepancies. Maintains records of financial transactions including revenue collected, co-payments and payment history by patient and respective insurance companies. Facilitates and prepares documents in accordance with Mass. Motor Vehicle Accident (MVA) protocol and Mass. General Law. Prepares patient financial statements and other appropriate documents for insurance processing. Provides patient support & assistance, either in person or via telephone, with professionalism and patience during difficult and confrontational issues.
Works under the supervision of the Patient Accounts & Services Manager who issues directives and evaluates performance.
- Performs timely and thorough follow-up actions on all unpaid patient account balances and post payments accordingly, consisting of third party insurance companies, private payers, contracts and UMass company accounts.
- Resolves discrepancies between claims and third party explanation of benefits. Processes all inquiries on accounts via written correspondence, telephone calls and/or insurance company websites. Determines accuracy of information, makes corrections, enters and/or edits information on University Health Services (UHS) practice management system for reprocessing of claims.
- Appeals third party insurance denied claims by research of medical notes, corrected insurance information, accurate medical coding, and timely filing. Completes and processes appeal forms with appropriate documentation via mail or website.
- Advocates on behalf of patient account inquiries with appropriate payers. Reviews accuracy of patient account balances, including tracking of all co-payments and payment history made by patients and insurance companies. Acts as liaison between patients and insurance company to resolve disputes.
- Posts payments, allowances, adjustments and refunds. Accepts credit card telephone payments.
- Performs timely and thorough follow-up collection actions on delinquent self-pay accounts through weekly generated trial balance reports. Issues Pre-Registration Hold and Pre-Collection letters to delinquent accounts. Place registration holds through SPIRE access for UMass students and remove registration holds from student records when accounts are resolved. Facilitates and arranges payment plans with patients. Corresponds with collection agency to send uncollectable accounts with proper documentation.
- Communicate with Bursars’ Office, Registrar’s Office and Graduate Registrar’s Office and other UMass Department and Outside Agencies relating to patient accounts.
- Corresponds with outside attorneys and bills motor vehicle accidents within MVA protocol and MA General Law. Follows guidelines for the release of medical information for claim processing. Researches maximum payments and liability for auto insurance coordination of benefit with third party insurance for continued payment.
- Invoices and follows up on claims for Workers Compensation injuries for both on and off campus workers. Works closely with Workers Compensation Personnel on campus and the Human Resources Division in Boston. Track and submit claim and National Drug Code (NDC) numbers on file to appropriate injury claim payers.
- Prepares monthly invoice for Amherst and Hampshire college contracts and services performed. Corresponds with college staff on follow up of invoices.
- Processes company accounts by preparing manual invoices utilizing information from the UHS practice management system. Performs campus billing via PeopleSoft recharge system. Posts journal transfers from on campus departments along with transfers received from other state departments, determine appropriate account and makes necessary adjustments. Communicates and follows up with various departments on outstanding balances.
- Attends training sessions with various contracted insurance companies to maintain current claim reimbursement requirements.
- Trains and instructs other staff on Accounts Receivable (Bar) application of UHS practice management system.
- Updates and maintains patient account policy & procedure manual.
- Provides back-up coverage for medical receivable specialist, cash posting specialist, and cashier, as required.
- Receives and processes incoming mail.
- Performs special projects, as assigned by Patient Accounts & Services Manager.
- Perform other duties as assigned.
Minimum Qualifications (Knowledge, Skills, Abilities, Education, Experience, Certifications, Licensure)
- High School diploma or equivalent.
- Claim processing experience.
- Data entry experience.
- Knowledge of third party insurance procedures and billing practices. Able to interpret insurance explanation of benefit remittances and follow up on problem areas.
- Knowledge and ability to adjust International Classification of Diseases, Tenth Edit (ICD-10) and Current Procedural Terminology (CPT) medical coding in accordance with Health Care Financing Administration (HCFA) rules and regulations.
- Knowledge of standard procedure and methods in handling and recording cash receipts and disbursements.
- Excellent customer service and telephone skills.
- Possess good computer skills, ability to operate various office equipment.
- Ability to work accurately under pressure, ability to deal tactfully with others and to exercise sound judgment and discretion in handling confidential information.
- Ability to communicate and follow detailed instructions in English, both orally and in writing, to develop ideas in logical sequence.
- Ability to read and interpret documents such as financial reports, accounts and ledgers.
- Ability to work independently and in a team setting.
Qualifications Acquired on Job
- Knowledge of UHS policies and procedures.
- Knowledge of the current patient management system software, PeopleSoft and Excel.
- Detailed knowledge of third party insurance carriers and their corresponding websites.
- Detailed knowledge of the Student Health Fee and Student Health Benefit Plan.
- Knowledge of HIPAA and FERPA compliance.
- Knowledge of Medical terminology.
Monday through Friday, 8:00 am – 4:30 pm, 37.5 hours per week.
Physical Demands/Working Conditions
Typical medical clinic billing department environment activity.
Grade 13, Step 1
Special Instructions to Applicants
To apply for the position, please submit your application, along with a cover letter, resume, and the contact information for three professional references. The position will remain open until filled.
UMass Amherst is committed to a policy of equal opportunity without regard to race, color, religion, gender, gender identity or expression, age, sexual orientation, national origin, ancestry, disability, military status, or genetic information in employment, admission to and participation in academic programs, activities, and services, and the selection of vendors who provide services or products to the University. To fulfill that policy, UMass Amherst is further committed to a program of affirmative action to eliminate or mitigate artificial barriers and to increase opportunities for the recruitment and advancement of qualified minorities, women, persons with disabilities, and covered veterans. It is the policy of the UMass Amherst to comply with the applicable federal and state statutes, rules, and regulations concerning equal opportunity and affirmative action.