Temporary Clinical Business Operations Representative - Pediatrics

Job description

Job location: Miami, FL


Employment Type: Full-time
Posted data: 2020-08-26
Req: R100041270
Current Employees:If you are a current Staff, Faculty or Temporary employee at the University of Miami, please click here to log in to Workday to use the internal application process. To learn how to apply for a faculty or staff position using the Career worklet, please review this tip sheet.

Transforming Lives

The University of Miami is among the top research universities and academic medical centers in the nation, and one of the largest private employers in South Florida.

With more than 16,000 faculty and staff, the University strives for excellence, and is driven by a powerful mission to transform and impact the lives of its students, patients, members of the community, and people across the globe.

The University is committed to fostering a culture of belonging, where everyone feels valued and has the opportunity to add value. Through values of Diversity, Integrity, Responsibility, Excellence, Compassion, Creativity, and Teamwork (DIRECCT) the U community works together to create an environment driven by purpose, excellence, community, and service.

JOB SUMMARY

The Clinical Business Operations Representative facilitates the prompt resolution of problems related to pre and post care that arise in daily clinical operations. The incumbent in this position performs general administrative and receptionist functions, to include answering incoming calls, efficient management of patients, and the acquisition of necessary patient-care and records. This role will also assist patients in a courteous, efficient and professional manner and ensure adherence to divisional and departmental service standards.


JOB FUNCTIONS

  • Reviews patient charts including demographic, patient/guarantor information, procedures/charges and diagnosis codes for accuracy and correctness.
  • Reviews CPT and ICD-9 codes.
  • Assures that proper ICD-9 codes are used in order 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.
  • Previous Coding/Billing experience not required.

Other Duties

5%

  • 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.

50%

  • 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 persons 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.

QUALIFICATIONS:

Education:

High school diploma or equivalent

Experience:

Minimum 3 years of relevant experience

Knowledge, Skills and Attitudes:

  • 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.

Department Specific Functions

45%

  • Reviews patient charts including demographic, patient/guarantor information, procedures/charges and diagnosis codes for accuracy and correctness.
  • Reviews CPT and ICD-9 codes.
  • Assures that proper ICD-9 codes are used in order 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.
  • Previous Coding/Billing experience not required.

Other Duties

5%

  • 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.

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.

Patient safety is a top priority. As a result, during the Influenza ("the flu") season (September through April), the University Of Miami Miller School Of Medicine requires all employees who provide ongoing services to patients, work in a location (all Hospitals and clinics) where patient care is provided, or work in patient care or clinical care areas, to have an annual influenza vaccination. Failure to meet this requirement will result in rescinding or termination of employment.

The University of Miami is an Equal Opportunity Employer - Females/Minorities/Protected Veterans/Individuals with Disabilities are encouraged to apply. Applicants and employees are protected from discrimination based on certain categories protected by Federal law. Click here for additional information.

Job Status:

Full time

Employee Type:

Temporary

Pay Grade:

c103

 

 

 

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Job No:
Posted: 8/28/2020
Application Due: 9/18/2020
Work Type:
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