Clinical Business Operations Representative 2 (H)

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The University of Miami Health System, "UHealth", Department of Pediatrics-Infectious Diseases has an exciting opportunity for a Full-time Clinical Business Operations Representative 2 to work in Miami.

The Clinical Business Operations Representative 2 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 2 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: 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

• Validates parking for HIV patients. Collaborates with the Pediatric Coordinator to ensure monthly reports are submitted and parking validations are replenished.

• Attends weekly Children’s Medical Services interdisciplinary care coordination meetings with accurate pre-visit insurance verification reporting

• Alerts the clinical team immediately regarding special insurance issues, such as Ryan White enrollment due dates, that may affect patient care and laboratory specifications

• Financially clears Ryan White sponsored patients in UChart when confirmed

• Schedules appointments per individual provider specifications

• Notifies staff immediately for patients who present with untoward symptoms such as excessive coughing, complaints of fever, rash, etc.

• Assist with clinic flow by monitoring/assisting the nursing staff with patient visit needs

• Participates in learning modules designed to achieve Joint Commission Accreditation standards.

• Caring for perinatally exposed/infected HIV patients specializing in their considering their sensitive and complex social needs

• Required to stay current with the multiple insurance plans encountered, providing advocacy for the patients and preventing visit cancellations

• Required to work confidentially with Ryan White patients, making frequent community-based case management contacts, and will alert the team to ensure uninterrupted eligibility for HIV specific services.

• Will develop and maintain an SPSS data program to enter survey responses from CMS patients regarding satisfaction surveys; PDSA outcomes will also be included in this data base for future analysis and reporting to the CMS SNAQ team

• Will participate in biannual Quality Improvement projects developed by the interdisciplinary team

• Assist the Project Coordinator with the collection of patient data relevant to CQI projects as required by the project funding source, Health & Rehabilitative Services Administration (HRSA)

• Serve as the primary contact to collaborate with the Divisions’ providers