Ambulatory Service Rep, Otolaryngology, 40 Hours, Days

UMass Memorial Health•Worcester, MA

About The Position

The Ambulatory Service Rep performs complex administrative duties for patients needing routine or urgent appointments, medical procedures, tests, and related ancillary services in an ambulatory and outpatient setting. The role assesses patient needs, including requests for financial counseling, interpreter services, or social services, and refers patients to the appropriate person or area. It also alerts providers to emergent patient-care needs. The position supports patient access and clinic operations by welcoming patients, coordinating appointments and procedures, managing calls and patient information, assisting with insurance authorizations and referrals, and maintaining accurate administrative and billing records. It works with clinicians, insurers, patients, and other healthcare institutions according to established guidelines and within the role’s scope of authority.

Requirements

High school diploma.
Three years of related experience; this requirement is waived for candidates with an associate’s or bachelor’s degree.
Ability to use specialized application software and computer systems.
Ability to perform multiple functions and work under stressful situations.
Professional behavior and excellent communication and human-relations skills.

Nice To Haves

Associate’s or bachelor’s degree.
Knowledge of business office procedures and medical terminology or procedures.

Responsibilities

Greet visitors and patients for scheduled or urgent appointments and procedures.
Confirm and verify patient demographic and insurance information.
Collect patient co-payments when applicable; maintain related records and make daily deposits as required.
Obtain patient or guardian signatures for treatment authorization and insurance or billing information.
Assess patient needs, including financial counseling, interpreter services, and social services, and refer patients to appropriate resources.
Receive and direct phone calls; connect patient calls to providers or respond and take messages as directed.
Schedule urgent-care appointments as directed by clinicians.
Schedule patients with multiple providers and treatment areas, and arrange associated tests and procedures according to established guidelines and criteria.
Prioritize appointments to support patient care and efficient use of clinical staff and resources.
Provide patients with test and procedure preparation information verbally, by mail, or through the patient portal as needed.
Collaborate with insurers to obtain prior authorizations for procedures and tests; ensure required pre-authorizations, pre-certifications, and clinician referrals are obtained before visits.
Comply with referral-management regulations and verify eligibility for procedures or tests at other healthcare institutions.
Follow up to correct discrepancies.
Facilitate prescription-renewal matters within scope of authority and as directed by clinicians.
Prepare patient information for clinicians before scheduled visits as needed.
Scrub Patient Encounter information and submit it electronically.
Review and audit billing discrepancy reports and research errors for resolution as directed by office or clinical management.
Maintain accurate and timely records, logs, charges, files, and related information.
Perform administrative and clerical duties, including retrieving files, distributing mail and records, faxing, collating, data entry, and relaying messages.
Prepare special reports or spreadsheets for clinicians as requested.
Calculate daily co-payment totals for submission for reconciliation.
Compose or select standard form letters for clinician responses to routine inquiries and procedures.
Comply with departmental policies, procedures, objectives, health and safety requirements, and applicable quality-improvement practices.
Attend meetings, conferences, and seminars as required or directed.
Demonstrate respect, professionalism, tolerance, civility, and acceptance toward employees, patients, and visitors.
Maintain regular, reliable, and predictable attendance and perform other similar duties as required or directed.