Sr. Surgery Services Representative (H) Full Time Bascom Palmer Eye Institute Miami, FL

University of Miami•Miami, FL

2d•Onsite

About The Position

The University of Miami, Bascom Palmer Eye Institute, has an exciting full time opportunity for a Senior Surgery Services Representative for the Department of Patient Access in Miami, Florida. The Senior Surgery Services Representative oversees and serves as source of knowledge for junior representatives with the goal of ensuring an excellent healthcare experience for patients. Additionally, the Senior Surgery Services Representative supervises scheduling, reconciliation, and credentialing functions of the department to ensure compliance with guidelines. CORE JOB FUNCTIONS Acquires operating room schedules and reconciles surgical and anesthesia records. Verifies insurance information and takes appropriate steps to obtain any missing information. Works directly with billing staff and physicians to ensure medical records are complete and in compliance with regulations. Maintains an organized record of charges by batching patient records by date of service. Responds to and resolves complex costumer grievances. Adheres to University and unit-level policies and procedures and safeguards University assets. This list of duties and responsibilities is not intended to be all-inclusive and may be expanded to include other duties or responsibilities as necessary. CORE QUALIFICATIONS Education: High School diploma or equivalent Experience: Minimum 3 years of relevant experience Knowledge, Skills and Attitudes: Ability to communicate effectively in both oral and written form. Skill in completing assignments accurately and with attention to detail. Ability to process and handle confidential information with discretion. Ability to work independently and/or in a collaborative environment. Proficiency in computer software (i.e. Microsoft Office). Department Specific Functions: 1.Schedules and registers patients as per established policies and procedures in both the UChart and CARE systems. 2.Performs these tasks accurately with attention to detail to ensure the highest quality of standards and in accordance with all HIPAA guidelines relating to patient confidentiality and privacy. 3.Locates clinic chart, out guides clinic chart to appropriate area and makes copies of clinical notes. 3.Obtains pertinent documents from patients and makes copies for scanning into the UChart scanning system. 4.Validates patient identification by using two main identifiers in addition to patient name (Date of Birth, Social Security Number, and/or Medical Record Number). 5.Creates visit and ensures that the appropriate Patient Type & Location is used during the registration process since this task directly affects the billing process, clinical systems outcome and medical records management. 6.Reviews and verifies registration data in UChart and makes any appropriate changes as necessary including insurance coverage information, Bypass warnings, registration work queues, and completion of Medicare Secondary Payer Questionnaire, if applicable. 7.nterviews patient to determine financial classification status. Reviews financial liability with each patient and explains hospital and professional fees, as well as Global and Flat Fee options. Explains insurance benefits/coverage, if applicable and collects required financial liability. Refers patients unable to meet financial obligations to the on-site Financial Counselor. Documents all financial transactions in UChart. 8.informs the patient of all required forms, obtains all required signatures, and distributes copies accordingly. 9.Ensures accurate billing of services rendered by checking that the appropriate Financial Status Classification (FSC) and insurance plan has been selected in accordance with UMMG and Hospital Division contract summary protocols and that insurance is pre-verified by performing the following tasks: 10.Review visit and check that the FSC and insurance plan are the appropriate and applicable ones according to insurance or self-pay/global study status. • Refer to Insurance Verifier or verify by utilizing the on line web sites or telephone services, and obtaining eligibility and benefits, as well as, authorizations and referrals, if required. • Identify non-contracted HMO payers and work with the Business Development Department to ensure that a single case negotiation has been executed. • Enter all relevant data into the UChart Auth-Cert Referrals Module, link data to the appropriate visit and complete the required data elements in UChart to ensure that accurate billing data is submitted to the appropriate insurance 11. Collects all co-payments, co-insurance amounts, deductibles, and non-covered amounts for both Hospital & Professional prior to surgery. 12. Coordinates patient activities and checks to ensure that pre-operative, post operative and surgery dates are booked in UChart and CARE and informs physician of dates through email. 13. Utilizing the CARE system identifies surgical procedures and reviews physician orders. If applicable, orders tissue as per established guidelines. 14. Creates both a financial and a medical file and checks to see that physician has completed all the required forms. 15. Obtains information from patient and completes discharge planning form. 16. Performs the required compliance-checker process (use of the Health Works ABN Compliance Checker software) for all diagnostic services being rendered to all Medicare patients (about 30% of the patient population) to ensure medical necessity and inform patients of any testing that may not be covered so that patients understand their potential financial liability and sign the required Advance Beneficiary Notice (ABN) form, if applicable. 17. Creates a Patient Identification wristband for each patient as part of the Risk Management protocols and validates it upon placing the wristband. 18. Notifies Medical Clearance staff of patient’s arrival. Escorts patient to the designated area to begin the pre-admission medical clearance work up. 19. Follows through with each patient to ensure that any medical problems, HMO’s lab work and EKG’s are cleared and completed by the patient’s physician. 20. Arranges for bed assignment, if applicable. 21. Performs other duties as assigned. 22. Performs all tasks as stated above paying attention to detail and providing excellent customer service skills with Patients, Physicians, and all other related members. This would include following the Standard of Excellence & Accountability Policy that is provided through the Miller School of Medicine. 23. Assist department’s manager with the day to day operations and supervises Surgery Services Representatives in his/her absence. 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. The University of Miami is an Equal Opportunity Employer. Applicants and employees are protected from discrimination based on certain categories protected by Federal law. Job Status: Full time Employee Type: Staff The mission of the University of Miami is to transform lives through education, research, innovation, and service. A vibrant and diverse academic and healthcare community, the University of Miami and the University of Miami Health System ("UHealth") have rapidly progressed to become one of the nation’s top research universities and academic medical centers in the nation. The University comprises 12 schools and colleges serving undergraduate and graduate students in more than 350 majors and programs. Visit welcome.miami.edu/about-um to learn more about our points of pride. The University ranks No. 55 on U.S. News & World Report’s 2022 Best Colleges list and ranked No. 49 in the 2022 Wall Street Journal/Times Higher Education College Rankings. Bascom Palmer Eye Institute is ranked the #1 eye hospital in the USA and offers some of the nation's premiere eye doctors to treat every eye condition for adults. Sylvester Comprehensive Cancer, part of the Miller School of Medicine, received the prestigious National Cancer Institute designation in 2019. The University of Miami and UHealth have also ranked among the Forbes Best Employers and Best Employers for Women on several occasions, most recently in 2022. With more than 17,000 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 of Miami is an Equal Opportunity Employer. Applicants and employees are protected from discrimination based on certain categories protected by Federal law.

Requirements

High School diploma or equivalent
Minimum 3 years of relevant experience
Ability to communicate effectively in both oral and written form.
Skill in completing assignments accurately and with attention to detail.
Ability to process and handle confidential information with discretion.
Ability to work independently and/or in a collaborative environment.
Proficiency in computer software (i.e. Microsoft Office).

Responsibilities

Acquires operating room schedules and reconciles surgical and anesthesia records.
Verifies insurance information and takes appropriate steps to obtain any missing information.
Works directly with billing staff and physicians to ensure medical records are complete and in compliance with regulations.
Maintains an organized record of charges by batching patient records by date of service.
Responds to and resolves complex costumer grievances.
Adheres to University and unit-level policies and procedures and safeguards University assets.
Schedules and registers patients as per established policies and procedures in both the UChart and CARE systems.
Performs these tasks accurately with attention to detail to ensure the highest quality of standards and in accordance with all HIPAA guidelines relating to patient confidentiality and privacy.
Locates clinic chart, out guides clinic chart to appropriate area and makes copies of clinical notes.
Obtains pertinent documents from patients and makes copies for scanning into the UChart scanning system.
Validates patient identification by using two main identifiers in addition to patient name (Date of Birth, Social Security Number, and/or Medical Record Number).
Creates visit and ensures that the appropriate Patient Type & Location is used during the registration process since this task directly affects the billing process, clinical systems outcome and medical records management.
Reviews and verifies registration data in UChart and makes any appropriate changes as necessary including insurance coverage information, Bypass warnings, registration work queues, and completion of Medicare Secondary Payer Questionnaire, if applicable.
Interviews patient to determine financial classification status. Reviews financial liability with each patient and explains hospital and professional fees, as well as Global and Flat Fee options. Explains insurance benefits/coverage, if applicable and collects required financial liability. Refers patients unable to meet financial obligations to the on-site Financial Counselor. Documents all financial transactions in UChart.
Informs the patient of all required forms, obtains all required signatures, and distributes copies accordingly.
Ensures accurate billing of services rendered by checking that the appropriate Financial Status Classification (FSC) and insurance plan has been selected in accordance with UMMG and Hospital Division contract summary protocols and that insurance is pre-verified by performing the following tasks:
Review visit and check that the FSC and insurance plan are the appropriate and applicable ones according to insurance or self-pay/global study status.
Refer to Insurance Verifier or verify by utilizing the on line web sites or telephone services, and obtaining eligibility and benefits, as well as, authorizations and referrals, if required.
Identify non-contracted HMO payers and work with the Business Development Department to ensure that a single case negotiation has been executed.
Enter all relevant data into the UChart Auth-Cert Referrals Module, link data to the appropriate visit and complete the required data elements in UChart to ensure that accurate billing data is submitted to the appropriate insurance
Collects all co-payments, co-insurance amounts, deductibles, and non-covered amounts for both Hospital & Professional prior to surgery.
Coordinates patient activities and checks to ensure that pre-operative, post operative and surgery dates are booked in UChart and CARE and informs physician of dates through email.
Utilizing the CARE system identifies surgical procedures and reviews physician orders. If applicable, orders tissue as per established guidelines.
Creates both a financial and a medical file and checks to see that physician has completed all the required forms.
Obtains information from patient and completes discharge planning form.
Performs the required compliance-checker process (use of the Health Works ABN Compliance Checker software) for all diagnostic services being rendered to all Medicare patients (about 30% of the patient population) to ensure medical necessity and inform patients of any testing that may not be covered so that patients understand their potential financial liability and sign the required Advance Beneficiary Notice (ABN) form, if applicable.
Creates a Patient Identification wristband for each patient as part of the Risk Management protocols and validates it upon placing the wristband.
Notifies Medical Clearance staff of patient’s arrival. Escorts patient to the designated area to begin the pre-admission medical clearance work up.
Follows through with each patient to ensure that any medical problems, HMO’s lab work and EKG’s are cleared and completed by the patient’s physician.
Arranges for bed assignment, if applicable.
Performs other duties as assigned.
Performs all tasks as stated above paying attention to detail and providing excellent customer service skills with Patients, Physicians, and all other related members. This would include following the Standard of Excellence & Accountability Policy that is provided through the Miller School of Medicine.
Assist department’s manager with the day to day operations and supervises Surgery Services Representatives in his/her absence.