Clinical Business Operations Representative 3 (H)

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The University of Miami Health System, "UHealth", Department of Pediatrics- Early Steps, has an exciting opportunity for a full-time Clinical Business Operations Representative 3 to work in Miami.

The Clinical Business Operations Representative 3 facilitates the prompt resolution of problems related to pre- and post-care that arise in daily clinical operations. The incumbent performs general administrative and receptionist functions, to include answering incoming calls, efficient management of patients, and the acquisition of necessary patient care and records. The Clinical Business Operations Representative 3 (H) assists patients in a courteous, efficient and professional manner and ensures adherence to divisional and departmental service standards.

Core Responsibilities:            

• Assists the department in managing expectations surrounding pre- and post-patient care.

• Obtains or reviews all patient demographic information, insurance information, and referral numbers.

• Reviews clinical records for completeness including authorization, signatures, missing data, and other patient information.

• Answers multiple telephones for the department: triages incoming calls, responds to questions, directs calls, and documents messages in the appropriate software.

• Greets visitors and callers, handles their inquiries, and directs them to the appropriate employee according to their needs.

• Works cooperatively with fellow employees to solve problems and enhance the smooth and efficient flow of the practice.

• Provides coverage for responsibilities of co-workers when assigned or as need arises.

• Develops and promotes the use of effective methods of communicating with physicians, managers, peers, trainees, and staff on a regular basis.

• Maintains confidentiality of all information.

• Adheres to University and unit-level policies and procedures and safeguards University assets. 

Department Specific Functions:

• Reviews patient charts including demographic, patient/guarantor information, procedures/charges and diagnosis codes for accuracy and correctness.

• Reviews CPT and ICD-10 codes.

• Assures that proper ICD-10 codes are used to bill Medicaid or other Third-Party payors.

• Ensures patients are registered in Epic and updates insurance information and guarantor.

• Keeps updated with coding guidelines and reimbursement reporting requirements.

• Obtains Medicaid/ HMO/MediPass authorizations and referrals information.

• Reviews and edits all office billing charge encounter forms assuring accuracy prior to sending them to billing office.

• Works closely with the Billing Office staff and Compliance to ensure that the appropriate documents are obtained that are required to bill the payer.

• Posts Medicaid and other 3rd party payments in the CMS Database system.

• Processes refunds to Medicaid for Targeted Case Management and re-bills when errors are detected.

• Inputs services into the State database for Children’s Medical Services (CMS) data system.

• Reviews Direct Services invoices processed by Medical Biller for accuracy before they are submitted to Accounts Payable.

• Keeps an updated spreadsheet on provider payments.

• Communicates identified problems to Supervisor / Fiscal Manager and makes recommendations as appropriate.

• Generates fiscal billing and data reports from imputed data on a monthly basis and whenever needed.

• Performs other job-related duties within job scope as requested by Fiscal Manager.

This list of duties and responsibilities is not intended to be all-inclusive and may be expanded to include other duties or responsibilities as necessary.

CORE QUALIFICATIONS:                                                                                                    

• High school diploma or equivalent

• Minimum 2 years of relevant experience

• Skill in data entry with minimal errors.

• Ability to communicate effectively in both oral and written form.

• Ability to work evenings, nights, and weekends as necessary.

• Skill in collecting, organizing, and analyzing data.

• Ability to work independently and/or in a collaborative environment.

• Commitment to the University’s core values.

Any appropriate combination of relevant education, experience and/or certifications may be considered.

The University of Miami offers competitive salaries and a comprehensive benefits package including medical, dental, tuition remission and more.

UHealth-University of Miami Health System, South Florida's only university-based health system, provides leading-edge patient care powered by the ground breaking research and medical education at the Miller School of Medicine. As an academic medical center, we are proud to serve South Florida, Latin America and the Caribbean. Our physicians represent more than 100 specialties and sub-specialties, and have more than one million patient encounters each year. Our tradition of excellence has earned worldwide recognition for outstanding teaching, research and patient care. We're the challenge you've been looking for.

The University of Miami is an Equal Opportunity Employer. Applicants and employees are protected from discrimination based on certain categories protected by Federal law.

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