Careers at UMass Amherst

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

The Clerk IV - Patient Benefit and Referral Specialist 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 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 (Knowledge, Skills, Abilities, Education, Experience, Certifications, Licensure)

• Associate Degree from an accredited Medical Assistant Program, successful completion of certification as a Certified Medical Assistant or high school diploma with at least three (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 (Knowledge, Skills, Abilities, Education, Experience, Certifications, Licensure)

Experience in a multi-practice facility.

Physical Demands/Working Conditions

Typical health care clinic environment activity.

Additional Details

This position is designated as essential personnel.

Work Schedule

Monday - Friday, 8:00am – 4:30pm (37.50 hours per week).

Salary Information

Grade 13

Special Instructions to Applicants

Along with the application, please submit a resume. References will be checked at the finalist stage. Please be prepared to provide contact information for three (3) professional references.