Clinical Business Operations Representative 3

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The University of Miami/UHealth Department of Pediatrics has an exciting opportunity for a full time Clinical Business Operations Representative III to work in Miami, FL.

The Clinical Business Operations Representative III (H) in General Pediatrics supports high-volume pediatric outpatient operations across multiple clinic locations within an academic clinical environment. This role functions with a high degree of autonomy and operational responsibility, ensuring seamless patient access, provider scheduling coordination, referral and authorization management, and clinical operations support with revenue integrity.

CORE JOB FUNCTIONS                                                                                                     

• 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:

Pediatric Scheduling & QGenda Administration

• Maintain and manage faculty and resident provider schedules within QGenda, including template creation, call coverage assignments, PTO processing, and schedule modifications.
• Proactively identify and resolve scheduling conflicts to prevent clinical disruptions and maintain provider productivity.
• Coordinate provider coverage across multiple clinic locations to ensure continuity of care and operational efficiency.
• Communicate real-time schedule changes to faculty, residents, and clinic staff.

Referrals & Authorizations

• Verify insurance eligibility and benefits for pediatric patients, including Medicaid managed care, HMO, and commercial plans.
• Obtain, manage, and track prior authorizations for services, procedures, and specialty referrals.
• Initiate and monitor referrals to subspecialists and diagnostic services to ensure timely patient access.
• Communicate with insurance carriers, external provider offices, and families to resolve pending or denied authorizations.
• Maintain detailed and accurate documentation of all referral and authorization activity within the electronic health record (EHR).
• Monitor outstanding authorizations, referrals, and incomplete documentation to ensure timely follow-up and minimize delays in patient care.

Multi-Site Operational Coverage

• Provide independent front-end operational support across multiple pediatric clinic locations as assigned.
• Adapt to site-specific workflows while maintaining consistent service, compliance, and operational standards.
• Support staffing coverage during high-volume periods, provider absences, or operational surges.
• Ensure uninterrupted patient access services across all assigned clinic locations

Clinical Operations Support & Revenue Integrity

• Review and confirm completion of daily clinical documentation to ensure accuracy, compliance, and billing readiness.
• Review clinical records for completeness, including authorizations, signatures, missing data, and other patient information.
• Verify that all charges for services rendered, including visits, procedures, and immunizations, are entered and submitted appropriately for