Clerk IV - Patient Services Representative

About UMass Amherst

The flagship of the Commonwealth, the University of Massachusetts Amherst is a nationally ranked public land-grant research university that seeks to expand educational access, fuel innovation and creativity, and share and use its knowledge for the common good. Founded in 1863, UMass Amherst sits on nearly 1,450-acres in scenic Western Massachusetts and boasts state-of-the-art facilities for teaching, research, scholarship, and creative activity. The institution advances a diverse, equitable, and inclusive community where everyone feels connected and valued—and thrives, and offers a full range of undergraduate, graduate and professional degrees across 10 schools and colleges, and 100 undergraduate majors. We believe every member of our university community can contribute to our ongoing success by striving for the highest level of excellence as we seek breakthrough solutions to mounting environmental, social, economic, and technological challenges in our world.

 

Job Summary

The Patient Services Representative accurately performs all functions related to the Student Health Benefit Plan (SHBP), including processing enrollments and waivers as well as verifying eligibility electronically via multi-payer systems to ensure the facility will be reimbursed for the services performed. This position enters and updates patient information in the practice manager in a timely manner and with a high degree of accuracy. Other responsibilities include collection of copays, fee-for-service payments, and windows payments and preparation of an electronic reconciliation of daily log.

 

Essential Functions

• Accurately performs all functions related to the Student Health Benefit Plan (SHBP), verifying eligibility for enrollment and third-party insurance used to waive out of the SHBP by verifying insurance electronically via multi-payer systems and entering or updating information in the practice manager in a timely manner.
• Reviews patient third party insurance benefits and educates and informs patients about their responsibilities including copays, deductibles, and coordination of benefits.
• Addresses electronic eligibility alerts and contacts patients whose insurances are inactive to ensure that full-time students have health insurance coverage as required by Massachusetts law.
• Collaborates with the Billing, Patient Benefits and, Referral specialist departments for maximizing reimbursement of services provided.
• Investigates and responds to questions from University Health Services (UHS) clinic staff and medical providers regarding SHBP coverage. 
• Provides patients with courteous, friendly, fast, and efficient services.
• Demonstrates current knowledge of commercial insurances and requirements of plans accepted at UHS.
• Speaks to students and families about the SHBP and its benefits at Student Orientation events.
• Extracts waiver files from the SHBP website daily during the open waiver and enrollment period each semester and sends report of student ID numbers to the Bursar to remove the SHBP fee from the tuition bill.
• Collects manual waivers and enrollments as well as screens for eligibility.
• Verifies students' University enrollment in credits to determine eligibility to enroll in the SHBP.
• Updates the practice management system with SHBP dates of enrollment.
• Upon approval of student family enrollment, creates charts for each family member in the practice management system.
• Compiles data for the manual waivers and enrollments in daily spreadsheets to communicate with the Bursar’s office to ensure that fees are added for enrollment and removed for waivers.
• Uses practice management system to send secure messages to students.
• Collects copays, co-insurance, deductibles and fee-for-services payments.
• Posts windows payments and online credit card payments into the medical system.
• Cross trains with front line staff to provide back-up staffing support when needed.
• Provides coverage to multiple different clinics run at UHS or across campus, including but not limited to Flu clinics, COVID vaccine and testing clinics, and STI clinics.
• Maintains patient confidentiality at all times utilizing current HIPAA guidelines.
• Participates in annual UHS training and monthly departmental meetings to improve the quality of services provided to patients.
• Provides administrative support to Supervisor of Patient Services.

 

Other Functions

Performs other duties as assigned.

 

Minimum Qualifications (Knowledge, Skills, Abilities, Education, Experience, Certifications, Licensure)

• High school diploma with at least 2 yea