Clinical Business Operations Representative 2

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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.

• 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.