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University of Massachusetts Amherst Clerk IV (Patient Benefit & Referral Specialist) in Amherst, Massachusetts

Clerk IV (Patient Benefit & Referral Specialist)

Apply now ( Job no: 521343

Work type: Staff Full Time

Location: UMass Amherst



Categories: Administrative & Office Support

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.

Job Summary

The Patient Benefit and Referral Specialist 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.

Essential Functions

  • Accurately performs 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.

  • 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 comply 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.

  • 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 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 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 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 reports to identify patients requiring 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 Text waiting system to alleviate patient wait times.

  • Manages UHS ParkMobile system accurately to provide parking privileges to patients in the designated lot.

  • Maintains patient confidentiality using current HIPAA guidelines.

    Other Functions

  • Tracks outgoing referrals for completion and compliance, compiles data and prepares reports on a monthly basis.

  • Provides cross-coverage and back-up staffing support to other functions of the front-line staff, when needed.

  • Participates in annual UHS training and monthly departmental meetings to improve the quality of service provided to patients.

  • Performs other related duties as assigned.

    Minimum Qualifications (Knowledge, Skills, Abilities, Education, Experience, Certifications, Licensure)

  • Associate Degree from an accredited Medical Assistant Program or successful completion of certification as a Certified Medical Assistant, or High School Diploma and at least three (3) years’ 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.

  • 35-week minimum position.

    Salary Information

    Grade 13

    Special Instructions to Applicants

    Please apply online and provide a resume and contact information for three (3) professional references.

    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.

Advertised: Nov 17 2023 Eastern Standard Time

Applications close: