Sr. Surgery Services Representative PBG
University of Miami

Job Info

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Current Employees:

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The University of Miami has an exciting opportunity for a Sr. Surgery Services Representative with Bascom Palmer Eye Institute in Palm Beach Gardens, Florida.

The individual in this position is responsible for coordinating all the functions and activities related to patient access and surgery coordination, including, but not limited to, front end customer service, scheduling of surgical procedure in CARE, ordering of tissue, scheduling of pre-admission medical clearance visits in UChart, accurate patient registration in UChart, discharge planning, transportation, and hotel arrangements. This position acts as liaison between patient, physician, and hospital and requires interaction with the medical staff of the University Of Miami Miller School Of Medicine, clinical and support staff, insurance companies, patients and their family members. In summation, this position supports the hospital's vision, mission, goals and objectives while focusing on the delivery of customer service excellence and efficient Patient Access services.

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

Certification and Licensing:

Not Applicable

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

• 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 assignments, if applicable.
  
• 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.
  

Supervision Received:
This position is supervised by the Manager, Patient Access

Supervision Exercised:

Surgery Service Representatives

Position Requirements:

• Experience in a hospital, clinic, or physician office setting or equivalent healthcare or customer service related field. Any appropriate combination of relevant education, skills and experience will be considered.
  
• Excellent interpersonal, written and oral communication skills.
  
• Able to interact and assist patients of all ages, cultural backgrounds, and special needs. Bi-lingual English & Spanish, or English and Creole a plus.
  

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:
Staff

Pay Grade:
c103

This job has expired.