Patient Service Representative III

Patient Service Representative III

The Patient Service Representative III serves as a key administrative support member within Student Health Services, part of Health, Well-being & Safety (HWS), a division at UC Riverside dedicated to providing students with resources and services that promote overall safety and well-being. HWS strives to be a model of excellence in higher education, fostering an environment where students can thrive, enhance, sustain, and support their personal growth and academic goals. Through its mission, HWS is committed to raising awareness and offering an inclusive framework of services, programs, and resources that cultivate community and holistic well-being. A significant component of this role involves supporting students enrolled in the University of California Student Health Insurance Plan (UC SHIP), a comprehensive, self-funded insurance program designed specifically for UC students and their dependents. UC SHIP provides medical, pharmacy, dental, vision, and mental health and substance use services, ensuring students have access to high-quality care on and off campus. Unlike traditional insurance plans, UC SHIP is a pooled-risk program that leverages the collective strength of UC students across all campuses, keeping costs low while maintaining comprehensive coverage. By actively engaging students in its design, UC SHIP is structured to meet student health needs efficiently and affordably, allowing them to focus on their academic success without the burden of high healthcare costs. Within this framework, the Patient Service Representative III plays a crucial role in ensuring that students can effectively navigate UC SHIP benefits and access the care they need. This position is responsible for insurance coordination, referral coordination, insurance waiver processing, front desk operations, scheduling, and student outreach. Exceptional customer service, strong attention to detail, and the ability to manage multiple responsibilities in a fast-paced healthcare environment are critical to success in this role. Additionally, the Patient Service Representative III must ensure compliance with HIPAA and FERPA regulations while providing accurate, timely information to students regarding their UC SHIP healthcare options. This position may also require providing backup administrative support to the Counseling and Psychological Services (CAPS) and Student Well-being Intervention & Follow-Up Team (SWIFT) departments, ensuring continuity of services when needed.

Experience Requirements

Minimum of 3-5 years of experience - Required

Experience with medical insurance plans, preferably UC SHIP, and the ability to interpret complex insurance language accurately. - Required

Customer service experience with excellent communication and interpersonal skills to effectively communicate with a diverse group of individuals and address complaints and problems. - Required

Experience using a medical practice management system and/or various electronic database - Preferred

Experience working with a culturally diverse workforce and constituency. - Preferred

Knowledge of State and Federal laws regarding the proper release of medical information. - Preferred

Familiarity with University of California policies and procedures and campus department functions. - Preferred

Special Conditions

May require occasional overtime based on clinical needs. - Required

The incumbent may be required to work either a standard schedule (Monday through Friday, 8:00 AM to 5:00 PM) or an alternative schedule consisting of four 10-hour days per week (4/10 schedule), as determined by departmental needs. This position requires on-site work; remote work is not available. - Required

Minimum Requirements

Excellent written and verbal communication skills, with a professional demeanor and strong customer service abilities.

Strong organizational, analytical, and time management skills to solve problems, prioritize workload, and compile, organize, and report information.

Proficiency in accurate data entry, typing, and record-keeping.

An ability to independently coordinate multiple, diverse, and simultaneous projects, maintaining accuracy and efficiency while meeting strict deadlines.

Knowledge of medical office procedures and terminology, with specific emphasis on UC SHIP and its processes.

Ability to work independently, use sound judgment to solve problems, and provide high-quality service to students.

Preferred Qualifications

Familiarity with eligibility requirements for the University of California Student Health Insurance Plan (UC SHIP).

Ability to determine compliance with HIPAA regulations by analyzing State and Federal laws.

Knowledge of medical documentation standards, particularly for primary care, mental health, women's health, radiology, and ultrasound services.

Understanding of health insurance industry terminology and billing practices, especially as they relate to UC SHIP.

In the heart of Inland Southern California, UC Riverside is located on nearly 1,200 acres near Box Springs Mountain in Southern California; the park-like campus provides convenient access to the vibrant and growing Inland region. The campus is a living laboratory for the exploration of issues critical to growing communities' air, water, energy, transportation, politics, the arts, history, and culture. UCR gives every student, faculty and staff member the resources to explore, engage, imagine and excel.

UC Riverside is recognized as one of the most ethnically diverse research universities in the country boasting several key rankings of which we are extremely proud.

• UC Riverside is proud to be ranked No. 12 among all U.S. universities, according to Money Magazine's 2020 rankings, and among the top 1 percent of universities worldwide, according to the 2019-20 Center for World University rankings.
• UC Riverside is the top university in the United States for social mobility. - U.S. News 2020
• UCR is a member of the University Innovation Alliance, the leading national coalition of public research universities committed to improving student success for low-income, first-generation, and students of color.
• Among top-tier universities, UC Riverside ranks No. 2 in financial aid. - Business Insider 2019
• Ranked No. 2 in the world for research, UCR's Department of Entomology maintains one of the largest collections of insect specimens the nation. - Center for World University Rankings
• UCR's distinguished faculty boasts 2 Nobel Laureates, and 13 members of the National Academies of Science and Medicine.

The University of California is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, age, protected veteran status, or other protected categories under state or federal law. It is the policy of the University of California to undertake affirmative action and anti-discrimination efforts, consistent with its obligations as a Federal and State contractor.

For information about our generous employee benefits package, visit: Employee Benefits Overview

General Information

Job Title: Patient Service Representative III

Job Code: 004722

Grade: Department Head Jackie Rodriguez

Supervisor: Erica Castillo

Department Custom Scope

The Patient Service Representative III serves as a key administrative support member within Student Health Services, part of Health, Well-being & Safety (HWS), a division at UC Riverside dedicated to providing students with resources and services that promote overall safety and well-being. HWS strives to be a model of excellence in higher education, fostering an environment where students can thrive, enhance, sustain, and support their personal growth and academic goals. Through its mission, HWS is committed to raising awareness and offering an inclusive framework of services, programs, and resources that cultivate community and holistic well-being. A significant component of this role involves supporting students enrolled in the University of California Student Health Insurance Plan (UC SHIP), a comprehensive, self-funded insurance program designed specifically for UC students and their dependents. UC SHIP provides medical, pharmacy, dental, vision, and mental health and substance use services, ensuring students have access to high-quality care on and off campus. Unlike traditional insurance plans, UC SHIP is a pooled-risk program that leverages the collective strength of UC students across all campuses, keeping costs low while maintaining comprehensive coverage. By actively engaging students in its design, UC SHIP is structured to meet student health needs efficiently and affordably, allowing them to focus on their academic success without the burden of high healthcare costs. Within this framework, the Patient Service Representative III plays a crucial role in ensuring that students can effectively navigate UC SHIP benefits and access the care they need. This position is responsible for insurance coordination, referral coordination, insurance waiver processing, front desk operations, scheduling, and student outreach. Exceptional customer service, strong attention to detail, and the ability to manage multiple responsibilities in a fast-paced healthcare environment are critical to success in this role. Additionally, the Patient Service Representative III must ensure compliance with HIPAA and FERPA regulations while providing accurate, timely information to students regarding their UC SHIP healthcare options. This position may also require providing backup administrative support to the Counseling and Psychological Services (CAPS) and Student Well-being Intervention & Follow-Up Team (SWIFT) departments, ensuring continuity of services when needed