Title: Clerk IV (Patient Benefit and Referral Specialist)
Executive Area: Administration and
Finance
College/School/MBU: Direct Medical Care
Department: Nursing Services
Work Location: Amherst
Schedule: Full 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 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
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 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.
Working Conditions
Work is performed in a standard office or indoor
university environment and involves minimal physical exertion.
Work Schedule and Work Arrangement
Monday -
Friday; 9:00AM – 5:00PM
Salary Information
Pay Grade: USA/MTA Grade 13
Click here to
view the Classified Step Scale
Special Instructions for 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.
This position will remain open for the time period required by any applicable collective
bargaining agreement and will continue until a suitable candidate pool is identified. Interested applicants are strongly encouraged to apply
early.
