Surgery Services Representative 3 - Full Time - Bascom Palmer Eye Institute - Doral, FL

University of Miami•Doral, FL

1d•Onsite

About The Position

The Surgery Services Representative 3 plays a pivotal role in coordinating surgery scheduling and frontend revenue cycle clinic functions. This position bridges the responsibilities of junior and lead representatives, ensuring an excellent healthcare experience for patients while supporting operational efficiency and compliance. The incumbent serves as a knowledgeable resource for the team and contributes to the enhancement of departmental processes.

Requirements

High School diploma or equivalent
Minimum 3 years of relevant experience
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

Responsibilities

Acquires and reconciles operating room schedules, surgical, and anesthesia records to ensure accuracy and compliance.
Verifies insurance information, confirms eligibility of patient coverage benefits, and obtains missing information from patients’ families or physicians’ offices.
Works directly with billing staff and physicians to ensure medical records are complete and in compliance with regulations.
Maintains organized records of charges by batching patient records by date of service and ensures accurate documentation in the system of record.
Responds to and resolves complex customer grievances.
Obtains necessary authorizations, pre-certifications, and referrals, and notifies patients of liabilities prior to date of service.
Creates estimates for both hospital and professional fees and collects funds as appropriate.
Monitors cancellations to maintain schedules and quickly identifies and fills cancelled slots to mitigate decreased provider productivity and loss of revenue.
Collaborates with scheduling departments to identify add-on patients and supports scheduling optimization.
Adheres to University and unit-level policies and procedures and safeguards University assets.
Establishes and maintains a close collaborative working relationship and open communication with providers, support clinical team, and patients.
Coordinates and schedules all pre-operative and post-operative visits, and surgical procedures promptly in the system in accordance with complex specialty provider instructions.
Validates patient identification by obtaining pertinent documents and verifying identity by using two main identifiers, and scanning documents into system.
Creates a patient identification band for each patient in accordance with patient safety and risk management protocols and validates information when placing the band.
Interviews patients and verifies demographic and financial registration data in electronic system and makes appropriate changes as necessary including insurance coverage information.
Conducts critical communication with patients and legal guardian facilitating the understanding of and obtaining signature on legal, ethical, and compliance related documents that must be presented and thoroughly explained to the patient or legal guardian prior to services being rendered.
Ensures all required documents, consents, implants, or tissues are available prior to procedure.
Verifies insurance information, obtains benefits, and determines financial classification.
Reviews and identifies discrepancies in auto generated estimates and creates accurate detailed hospital and professional estimates as needed.
Explains insurance benefits/coverages, global/flat fee options, and collects co-payments, deductibles, co-insurance, and non-covered amounts for both hospital & professional fees prior to surgery.
Promptly works all bypass warnings, registration work queues, and Medicare Secondary Payer Questionnaire, if applicable.
Confirms that Consent for Surgery has been signed by patient and provider and procedure listed is validated against surgery schedule, follows up if necessary.
Reviews and follows up with appropriate departments to ensure that all pre-op results are available prior to the procedure.
Orders, creates purchase orders, and keeps track of implants or tissues needed from external vendors, as needed.
Arranges for bed assignment or transfer, if applicable.
Works with healthcare team to resolve unique situations and troubleshoot issues.
Meets established individual and departmental key performance indicator goals: Co-pay, Previous Balances, Estimate Collections, Patient Satisfaction, Accuracy Rates, and Processing Time.
Responds to and resolves complex scheduling and billing inquiries, and patient grievances.
Cancels and reschedules all visits and surgeries as needed due to Provider Call Outs, or weather conditions.
Cross trained and able to float and cover other surgery specialties.
Serves as subject matter expert for the surgery specialty.