Ambulatory Service Rep, Pediatrics Clinic, 40 Hour, Days

About the role

At UMass Memorial Health, everyone is a caregiver – regardless of their title or responsibilities. Exceptional patient care, academic excellence and leading-edge research make UMass Memorial the premier health system of Central Massachusetts, and a place where we can help you build the career you deserve. We are more than 20,000 employees, working together as one health system in a relentless pursuit of healing for our patients, community and each other. And everyone, in their own unique way, plays an important part, every day.

Responsibilities

• Performs a variety of complex administrative duties for patients in need of routine and/or urgent appointments, medical procedures, tests, and associated ancillary services in an ambulatory in/outpatient setting.
• Assesses patients’ needs, including but not limited to financial counseling, interpreter services, and social services, and refers to appropriate person or area.
• Alerts providers to emergent patient care needs.
• Greets visitors and/or patients for scheduled and/or urgent care appointments and procedures.
• Confirms and verifies patient demographic and insurance information.
• Collects co-payments from patients upon arrival.
• Obtains signatures of consent from patient/guardian for treatment authorization and insurance/billing information.
• Receives and directs phone calls; connects the patient’s call to the provider or responds to the patient and takes messages as directed.
• Schedules urgent care appointments as needed and directed by clinicians.
• Schedules patients for treatment by multiple providers and treatment areas, and arranges a variety of associated tests and procedures according to established guidelines and specific criteria.
• Prioritizes appointments to foster optimum patient care, efficient utilization of clinical staff, and resources.
• Ensures tests and procedural prep information is provided to patients verbally, by mail, and/or via the patient portal as necessary.
• Collaborates with insurers to obtain patients’ prior-authorizations for procedures and tests as needed.
• Follows insurer guidelines to ensure pre-authorization, pre-certification, and clinician referrals for treatment are obtained prior to patient visits.
• Complies with referral management regulations.
• Verifies eligibility for procedures or tests from various health care institutions and follows up to correct discrepancies.
• Facilitates patient prescription renewal matters (via telephone, fax, and email) within scope of authority as directed by clinicians.
• Preps patient information for clinicians for scheduled visits as needed.
• Scrubs Patient Encounter information and submits electronically.
• Reviews and audits billing discrepancy reports and researches errors for resolution as directed by office or clinical management.
• Maintains accurate and timely records, logs, charges, files, and other related information as required.
• Performs a variety of related administrative and clerical duties such as retrieving files, distributing mail and other records, faxing, collating, data entry, and relaying messages to clinicians, residents, and staff.
• Prepares special reports or spreadsheets for clinicians as requested.
• Collects co-payments from patients for visits, maintains records, and makes daily cash deposits from patient visits.
• Calculates daily totals of co-payments received for submission to the second tier for co-payment reconciliation.
• Composes or selects standard form letters for clinicians’ response to routine inquiries and procedures (e.g., back-to-school authorizations).
• Complies with established departmental policies, procedures, and objectives.
• Attends meetings, conferences, and seminars as required or directed.
• Demonstrates use of Quality Improvement in daily operations.
• Complies with all health and safety regulations and requirements.
• Respects diverse views and approaches, demonstrates Standards of Respect, and contributes to creating and maintaining an environment of professionalism, tolerance, civility, and acceptance toward all employees, patients, and visitors.
• Maintains regular, reliable, and predictable attendance.
• Performs other similar and related duties as required or directed.

Qualifications

Education & Certification

• Required: High School Diploma.
• Preferred: Associate’s or Bachelor’s degree.

Experience & Skills

• Required: 3 years of related experience (waived if candidate holds an Associate’s or Bachelor’s degree).
• Required: Ability to use specialized applications software and computer systems.
• Required: Ability to work in a multifunctional capacity under stressful situations.
• Required: Professional behavior with excellent communication and human relations skills.
• Preferred: Knowledge of business office procedures and medical terminology/procedures.

Unless certification, licensure, or registration is required, an equivalent combination of education and experience providing proficiency in the areas of responsibility may be substituted for the above requirements. Department-specific competencies and their measurements are developed and maintained in individual departments.

Physical Demands

Work is considered sedentary. Position requires work indoors in a patient care environment.

Compensation

Hiring range: $20.94 – $29.27 per hour (based on a full-time schedule of 40 hours per week). The final offer will vary based on scheduled hours; compensation for part-time or reduced schedules will be prorated based on scheduled weekly hours, experience, skills, qualifications, and internal equity considerations. This position may have a signing bonus available; a member of the Recruitment Team will confirm eligibility during the interview process.

Schedule

• Monday through Friday, with every fourth weekend scheduled.
• Shifts: 7:30 am – 5:30 pm; 8-hour shifts with varying start times.
• Shift classification: Day Shift, 8 Hours.
• Full-time: 40 hours per week.

Additional Information

Exemption Status: Non-Exempt. Cost Center: 10020 – 4180 Pediatrics Clinic. Union: SHARE (State Healthcare and Research Employees).