Clinical Business Operations Representative 3

University of Miami•Miami, FL

16d

About The Position

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.

Requirements

High school diploma or equivalent
Minimum 2 years of relevant experience
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

Nice To Haves

Advanced knowledge of Cerner, Epic, and Qgenda preferred
Strong understanding of Medicaid managed care, HMO, and commercial pediatric insurance structures
Demonstrated ability to manage high-volume, multi-provider scheduling in a multi-site academic setting
Excellent communication skills when interacting with providers, residents, staff, and patients/families
High level of organization, accuracy, and independent problem-solving
Flexibility to support alternate clinic sites and varying schedules as operational needs require
Any relevant education, certifications and/or work experience may be considered.

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: 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.
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.
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.
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
Review and confirm completion of daily clinical documentation to ensure accuracy, compliance, and billing readiness.
Verify that all charges for services rendered, including visits, procedures, and immunizations, are entered and submitted appropriately for revenue cycle processing.
Collaborate with providers and clinical staff to resolve documentation discrepancies impacting billing and reimbursement.
Identify workflow inefficiencies and recommend process improvements to leadership to enhance operational performance and financial integrity.