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Everyone Is a Caregiver.
At UMass Memorial Health Care, Everyone is a Caregiver regardless of title. Exceptional patient care, academic excellence and leading-edge research make UMass Memorial the premier health care system of Central and Western Massachusetts, and a place where we can help you build the career you deserve. We are more than 14,000 employees, working together as one health care system. And everyone, in their own unique way, plays an important part, everyday.
Requisition #: 221651
Title: AMBULATORY SVCS REP
Location: UMass Memorial Medical Center
Posting Date: 12/06/2021
Shift: 1st shift
Union: Non - UNION
Shift Length: Monday through Friday 8a-430p
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. Assess patients’ needs, including but not limited to, financial counseling, interpreter services, 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.
- May collect co-payments from patients upon arrival.
- Obtains signatures of consent from patient/guardian for treatment authorization and insurance/billing information.
- Assess patients’ needs, including but not limited to, financial counseling, interpreter services, social services and refers to appropriate person or area.
- 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 in a manner that fosters optimum patient care, efficient utilization of clinical staff, as well as resources.
- Ensures tests and procedural prep information is provided to patients verbally, mail, and/or by the patient portal as necessary.
- Collaborates with insurers to obtain patients’ prior authorizations for procedures and tests as needed.
- Follows guidelines established by insurers to ensure that 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.
- Follows up to correct discrepancies.
- May facilitate patient prescription renewal matters, (via telephone, fax, and email), within scope of authority as directed by clinicians.
- Preps the patient’s information for clinicians for scheduled patient 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.
- May prepare special reports or spreadsheets for clinicians as requested.
- Collects co-payments from patients for visits, maintains records or 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 clinician’s response to routine inquiries and procedures, such as back-to-school authorizations.
Standard Staffing Level Responsibilities:
- Meets established productivity standards.
- Facilitates and promotes the sharing of knowledge and content throughout departments.
- Takes responsibility for ensuring that all work outcomes satisfy the UMass Memorial Health System True North.
- The individual must support the mission, vision, and goals of HealthAlliance-Clinton Hospital and serve as a role model for CARES values.
- Adheres to change control processes.
- Participates in cross training to optimize department resources.
- Demonstrates excellent attendance and actively participates in a variety of meetings and training sessions as required.
- Demonstrates a friendly, responsive, service-minded attitude to all internal and external customers.
- Communicates ideas effectively. Shares information and keeps others properly informed. Gives, and is open to useful feedback.
- Adheres to the HealthAlliance-Clinton Hospital Code of Conduct and Behavior Standards and dress code.
- Complies with established environment of care/safety policies and procedures and all health and safety requirements.
- Maintains and fosters an organized, clean and safe work environment.
- Contributes to the development and application of process improvements.
- Maintains a collaborative, team relationship with peers and colleagues in order to effectively contribute to the group’s achievement of goals and to help foster a positive work environment.
- Attends staff meetings and in-service programs as required or directed. Keeps current with hospital and unit changes by reading communication boards and/or books, bulletin boards, posted notices and reads and responds to e mails on a regular basis.
- Practices cost containment and fiscal responsibility through the efficient use of supplies, equipment, time, etc.
- Complies with established departmental policies, procedures and objectives.
- Attends variety of meetings, conferences, 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 Standard 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.
- High School Diploma
- Associate degree or higher
- Minimum one (1) year of related experience. This requirement is waived if candidate has Associate’s or Bachelor’s degree.
- Ability to use specialized applications software and computer systems
- Necessitates individuals who are multifunctional and able to work under stressful situations
- Exemplifies, professional behavior and excellent communication and human relations skills
- Knowledge of business office procedures and medical terminology/procedures
Standards of Respect: