Clinical Business Operations Representative 2

The University of Miami/UHealth Department of Pediatrics has an exciting opportunity for a full time Clinical Business Operations Representative 2 to work in Miami, FL. The Clinical Business Operations Representative 2 provides billing, coding, and fiscal data support for the program by reviewing patient records, charges, diagnoses, and insurance information for accuracy and compliance with Medicaid and other third-party payer requirements. Ensures appropriate coding, authorizations, billing documentation, and payment processing; maintains provider payment records and related databases; and works closely with the Billing Office, Compliance, and program leadership to resolve issues and support accurate and timely reimbursement. 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: triage 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. Ensures that the appropriate ICD-10 codes are used to bill Medicaid and other Third-Party payors. Ensures patients are accurately registered in Epic and verifies/ updates insurance coverage and guarantor information. Reviews Medicaid/ HMO/MediPass authorizations and referrals documentation to verify eligibility. Manually validates patient insurance coverage in the Early Steps Database System (ESDS) when necessary or upon request. Processes billing charge encounter forms and ensures timely submission to the Billing Office for claims processing. Works closely with the Billing Office staff and Compliance to ensure all required documentation and supporting information are obtained to bill the payer. Reviews contact notes and billing documentation for direct services in ESDS before submitting them for payment. Communicates issues and identified problems to providers and follows up to ensure corrections are made prior to submitting claims for payment in ESDS. Generates fiscal billing and data reports from ESDS upon request. Communicates identified problems to Supervisor / Fiscal Manager and makes recommendations as appropriate. Attends all required UChart/ Epic training and keeps updated with coding guidelines and reimbursement reporting requirements Performs other related duties within the scope of the position as assigned by the 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/relevant experience, certification or license Minimum 1 year of relevant experience required Excel, UChart, EPIC, CPT, ICD-10 Codes, Data Entry, HIPPA Claims processing, ESDS Flexible, reliable & multitasking Learning Agility: Ability to learn new procedures, technologies, and protocols, and adapt to changing priorities and work demands. Teamwork: Ability to work collaboratively with others and contribute to a team environment. Technical Proficiency: Skilled in using office software, technology, and relevant computer applications. Communication: Strong and clear written and verbal communication skills for interacting with colleagues and stakeholders. Any relevant education, certifications and/or work experience 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. Job Status: Full time Employee Type: Staff #J-18808-Ljbffr umiami