Ambulatory Service Rep

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Exemption Status:

Schedule Details:

Scheduled Hours:

Shift:

Hours:

Cost Center:

Union:

This position may have a signing bonus available a member of the Recruitment Team will confirm eligibility during the interview process.

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 16,000 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.

II. Major Responsibilities:

1. Greets visitors and/or patients for scheduled and/or urgent care appointments and procedures.
2. Confirms and verifies patient demographic and insurance information.
3. May collect co-payments from patients upon arrival.
4. Obtains signatures of consent from patient/guardian for treatment authorization and insurance/billing information.
5. Assess patients' needs, including but not limited to, financial counseling, interpreter services, social services and refers to appropriate person or area.
6. Receives and directs phone calls.
7. Connects the patient's call to the provider or responds to the patient and takes messages as directed.
8. Schedules urgent care appointments as needed and directed by clinicians.
9. 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.
10. Prioritizes appointments in a manner that fosters optimum patient care, efficient utilization of clinical staff, as well as resources.
11. Ensures tests and procedural prep information is provided to patients verbally, mail, and/or by the patient portal as necessary.
12. Collaborates with insurers to obtain patients' prior-authorizations for procedures and tests as needed.
13. Follows guidelines established by insurers to ensure that pre-authorization, pre-certification, and clinician referrals for treatment are obtained prior to patient visits.
14. Complies with referral management regulations.
15. Verifies eligibility for procedures or tests from various health care institutions.
16. Follows up to correct discrepancies.
17. May facilitate patient prescription renewal matters, (via telephone, fax, and email), within scope of authority as directed by clinicians.
18. Preps the patient's information for clinicians for scheduled patient visits as needed.
19. Scrubs Patient Encounter information and submits electronically.
20. Reviews and audits billing discrepancy reports and researches errors for resolution as directed by office or clinical management.
21. Maintains accurate and timely records, logs, charges, files, and other related information as required.
22. 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.
23. May prepare special reports or spreadsheets for clinicians as requested.
24. Collects co-payments from patients for visits, maintains records or makes daily cash deposits from patient visits.
25. Calculates daily totals of co-payments received for submission to the second tier for co-payment reconciliation.
26. Composes, or selects standard form letters for clinician's response to routine inquiries and procedures, such as back-to-school authorizations.

Standard Staffing Level Responsibilities:

1. Complies with established departmental policies, procedures and objectives.
2. Attends variety of meetings, conferences, seminars as required or directed.
3. Demonstrates use of Quality Improvement in daily operations.
4. Complies with all health and safety regulations and requirements.
5. 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.
6. Maintains, regular, reliable, and predictable attendance.
7. Performs other similar and related duties as required or directed.

All responsibilities are essential job functions.
Position Qualifications:
License/Certification/Education:

Required:
1. High School Diploma.
Preferred:
1. Associate's or Bachelor's degree.

Experience/Skills:

Required:
1. 3 years of related experience, this requirement is waived if candidate has Associate's or Bachelor's degree.
2. Requires the ability to use specialized applications software and computer systems.
3. Necessitates individuals who are multifunctional and able to work under stressful situations.
4. Exemplifies, professional behavior and excellent communication and human relations skills.
Preferred:
1. Knowledge of business office procedures and medical terminology/procedures preferred.

Unless certification, licensure or registration is required, an equivalent combination of education and experience which provides proficiency in the areas of responsibility listed in this description may be substituted for the above requirements.

Department-specific competencies and their measurements will be developed and maintained in the individual departments. The competencies will be maintained and attached to the departmental job description. Responsible managers will review competencies with position incumbents.

III. Physical Demands and Environmental Conditions:

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

All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability or protected veteran status.

We're striving to make respect a part of everything we do at UMass Memorial Health - for our patients, our community and each other. Our six Standards of Respect are: Acknowledge, Listen, Communicate, Be Responsive, Be a Team Player and Be Kind. If you share these Standards of Respect, we hope you will join our team and help us make respect our standard for everyone, every day.

As an equal opportunity and affirmative action employer, UMass Memorial Health recognizes the power of a diverse community and encourages applications from individuals with varied experiences, perspectives and backgrounds. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, sexual orientation, national origin, age, disability, gender identity and expression, protected veteran status or other status protected by law.

If you are unable to submit an application because of incompatible assistive technology or a disability, please contact us at talentacquisition@umassmemorial.org. We will make every effort to respond to your request for disability assistance as soon as possible.