Departmental Assistant - Patient Benefit and Referral Specialist

UMass Amherst•Amherst, NY

24d•Onsite

About The Position

The Departmental Assistant – Patient Benefit and Referral Specialist performs patient intake and administrative functions at University Health Services (UHS). The role interviews patients, verifies insurance eligibility and benefits through multi-payer systems, and enters or updates information in the practice management system accurately and promptly. It helps ensure reimbursement by obtaining pre-determinations and authorizations, educating patients about their financial responsibilities, and coordinating with billing and coding departments. The position also supports timely access to care through appointment scheduling, referral and order processing, phone management, and assistance to patients and providers. The role is part-time, onsite in Amherst, and works 20 hours per week on a schedule that varies according to departmental needs. The position maintains familiarity with accepted commercial insurance plans and their requirements, tracks referrals and prepares monthly reports, supports front-line staff through cross-coverage, and uses systems that support patient flow and parking privileges. Patient confidentiality must be maintained in accordance with current HIPAA guidelines. The employee participates in annual UHS training and monthly departmental meetings. The appointment is subject to final budgetary and administrative approval.

Requirements

Associate degree from an accredited Medical Assistant Program, successful completion of certification as a Certified Medical Assistant, or a high school diploma with at least 3 years of medical office experience.
Prior experience with insurance verification, authorization, and pre-determination.
Good oral and written communication skills, including telephone etiquette.
Knowledge of insurance plans and ability to understand and communicate detailed, complex health plan information to clientele.
Proficiency with practice management systems and electronic health records (EHR).
Excellent customer service skills and ability to de-escalate front-line customer service challenges.
Ability to communicate effectively with colleagues, the public, and other UHS staff.
Strong computer, typing, and oral communication skills, including telephone customer service skills.
Experience with Microsoft Excel or similar software.
Working knowledge of basic hospital or clinic practice management and medical terminology.

Nice To Haves

Experience in a multi-practice facility.

Responsibilities

Interview patients and complete patient intake, including electronic eligibility verification and timely, accurate entry or updating of information in the practice management system.
Provide benefit pre-determinations and explain patient responsibilities, including co-pays and coordination of benefits.
Address electronic eligibility alerts and notify patients with inactive insurance in advance.
Collaborate with Billing and Coding to maximize reimbursement for services provided.
Provide courteous, friendly, fast, and efficient service to patients.
Maintain current knowledge of commercial insurance plans and requirements accepted at UHS.
Track outgoing referrals, monitor completion and compliance, compile data, and prepare monthly reports.
Schedule and manage routine and walk-in appointments for a multidisciplinary practice according to provider guidelines.
Process referrals and orders for specialist groups and outside imaging facilities, including additional consideration for high-tech imaging requests before appointment scheduling.
Review insurance plans to determine authorization requirements and obtain required authorizations from primary care providers or insurers.
Manage incoming calls concerning appointments, prescription refills, test results, and messages to providers.
Prepare documentation and information relevant to patient appointments.
Process referrals from outside primary care providers for patients seeking continued care at UHS while on campus.
Review transaction codes and generate daily reports identifying patients requiring primary care provider approval; contact providers, send relevant notes, and enter received authorizations into the practice management system.
Use and manage systems that facilitate patient care, including the Trext waiting system.
Manage the UHS Parkmobile system to provide patient parking privileges in the designated lot.
Provide cross-coverage and backup staffing for other front-line functions as needed.
Maintain patient confidentiality in accordance with current HIPAA guidelines.
Participate in annual UHS training and monthly departmental meetings.
Perform other duties as assigned.