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AMBULATORY SERVICES REPRESENTATIVE

UMass Memorial Medical Center
Worcester

Job Description

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.

Qualifications

High School Diploma and 3+ years of related experience. Requires the ability to use specialized applications software and computer systems. Knowledge of business office procedures and medical terminology/procedures preferred. Necessitates individuals who are multifunctional and able to work under stressful situations. Exemplifies, professional behavior and excellent communication and human relations skills.

Major Responsibilities:

Receives and directs phone calls from patients and physician offices. 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 physicians clinical staff, as well as equipment and facilities.

Handles urgent patient care calls according to department protocol. May alert providers to emergent patient care symptoms and concerns. Connects the patients call to the provider or responds to the patient and takes messages as directed. Schedules urgent care appointments as needed and directed by physician.

Ensures tests and procedural prep information is provided to patients both verbally and by mail as necessary. Arrives and greets 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.

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 physician referrals for treatment are obtained prior to patient visits. Complies with referral management regulations established for primary care providers. 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 providers.

Batches and scrubs Patient Encounter forms and submits to applicable billing offices as needed. Reviews and audits billing discrepancy reports and researches errors for resolution as directed by office or clinical management. Calculates daily totals of co-payments received for submission to the second tier for co-payment reconciliation.

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 and other records, faxing, collating, data entry, and relaying messages to physicians, residents and staff. May prepare special reports or spreadsheets for physicians as requested.

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, and contributes in maintaining an environment of professionalism, tolerance, civility and acceptance toward all employees, patients and visitors.

Performs other similar and related duties as required or directed.

All responsibilities are essential job functions.

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