Clerk IV - Patient Services Representative

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 Patient Services Representative accurately performs all functions related to the Student Health Benefit Plan (SHBP), including processing enrollments and waivers as well as verifying eligibility electronically via multi-payer systems to ensure the facility will be reimbursed for the services performed. This position enters and updates patient information in the practice manager in a timely manner and with a high degree of accuracy. Other responsibilities include collection of copays, fee-for-service payments, and windows payments and preparation of an electronic reconciliation of daily log.

Essential Functions

• Accurately performs all functions related to the Student Health Benefit Plan (SHBP), verifying eligibility for enrollment and third-party insurance used to waive out of the SHBP by verifying insurance electronically via multi-payer systems and entering or updating information in the practice manager in a timely manner.
• Reviews patient third party insurance benefits and educates and informs patients about their responsibilities including copays, deductibles, and coordination of benefits.
• Addresses electronic eligibility alerts and contacts patients whose insurances are inactive to ensure that full-time students have health insurance coverage as required by Massachusetts law.
• Collaborates with the Billing, Patient Benefits and, Referral specialist departments for maximizing reimbursement of services provided.
• Investigates and responds to questions from University Health Services (UHS) clinic staff and medical providers regarding SHBP coverage.
• Provides patients with courteous, friendly, fast, and efficient services.
• Demonstrates current knowledge of commercial insurances and requirements of plans accepted at UHS.
• Speaks to students and families about the SHBP and its benefits at Student Orientation events.
• Extracts waiver files from the SHBP website daily during the open waiver and enrollment period each semester and sends report of student ID numbers to the Bursar to remove the SHBP fee from the tuition bill.
• Collects manual waivers and enrollments as well as screens for eligibility.
• Verifies students' University enrollment in credits to determine eligibility to enroll in the SHBP.
• Updates the practice management system with SHBP dates of enrollment.
• Upon approval of student family enrollment, creates charts for each family member in the practice management system.
• Compiles data for the manual waivers and enrollments in daily spreadsheets to communicate with the Bursar's office to ensure that fees are added for enrollment and removed for waivers.
• Uses practice management system to send secure messages to students.
• Collects copays, co-insurance, deductibles and fee-for-services payments.
• Posts windows payments and online credit card payments into the medical system.
• Cross trains with front line staff to provide back-up staffing support when needed.
• Provides coverage to multiple different clinics run at UHS or across campus, including but not limited to Flu clinics, COVID vaccine and testing clinics, and STI clinics.
• Maintains patient confidentiality at all times utilizing current HIPAA guidelines.
• Participates in annual UHS training and monthly departmental meetings to improve the quality of services provided to patients.
• Provides administrative support to Supervisor of Patient Services.

Other Functions

Performs other duties as assigned.

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

• High school diploma with at least 2 years of medical office experience.
• Prior experience in medical setting and speaking with the public.
• Prior experience with insurance verification and benefit levels.
• Prior experience in insurance or insurance administration.
• Strong computer, typing and oral communication skills including telephone etiquette.
• Experience working with Microsoft Excel or similar software.
• Ability to understand and communicate detailed and complex health plan information to clientele.
• Practice management and Electronic Health Records proficiency.
• Excellent customer service skills and the ability to deescalate frontline customer service challenges.
• Ability to perform data entry functions and numerical computations.
• Ability to effectively communicate with colleagues, the public, and other UHS staff.

Physical Demands/Working Conditions

Typical health clinic office environment.

Additional Details

Qualifications Acquired on Job:

• Detailed knowledge of health plans offered by UHS.
• Ability to use and understand all aspects of the Medical Management System.
• UHS policies and procedures.
• Clerical functions.
• Increased insurance knowledge.
• Use of web-based clearing houses to determine eligibility and benefit information for third party insurance.
• Explanation of benefits, enrollment and eligibility for the multilevel student health plan.
• Knowledge of UHS financial policies and procedures.
• Knowledge of HIPAA.

Work Schedule

Monday - Friday; 8:30am - 5:00pm.

Salary Information

USA/MTA 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.

UMass Amherst is committed to a policy of equal opportunity without regard to race, color, religion, caste, creed, sex, age, marital status, national origin, disability, political belief or affiliation, pregnancy and pregnancy-related condition(s), veteran status, sexual orientation, gender identity and expression, genetic information, natural and protective hairstyle and any other class of individuals protected from discrimination 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 UMass Amherst to comply with the applicable federal and state statutes, rules, and regulations concerning equal opportunity and affirmative action.