Clinical Business Operations Representative 3

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Clinical Business Operations Representative 3

The University of Miami/UHealth department of Neurology has exciting opportunity for a Full Time Clinical Business Operations Representative 3 to work in Miami, FL. The Clinical Business Operations Representative 3 facilitates the prompt resolution of problems related to pre- and post-care that arise in daily clinical operations. The incumbent performs general administrative and receptionist functions, to include answering incoming calls, efficient management of patients, and the acquisition of necessary patient care and records. The Clinical Business Operations Representative 3 assists patients in a courteous, efficient and professional manner and ensures adherence to divisional and departmental service standards.

Core 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.
• •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.

Department Specific Functions

Patient Access and Scheduling

Answer incoming calls, manage patient messages through UChart, and respond to inquiries from patients, providers, and internal and external customers. Route clinical concerns requiring assessment to appropriate licensed clinical personnel.

Coordinate and optimize physician clinical schedules, including appointment availability, cancellations, rescheduling, and unanticipated openings to maximize patient access.

Serve as a primary point of contact for patient scheduling and coordination across UHealth clinical locations and satellite facilities.

Collaborate with clinical operations staff, providers, and scheduling teams to ensure efficient patient flow, appointment coordination, and continuity of clinical services.

Support Rapid Care scheduling workflows, including appointment scheduling, patient confirmations, scheduling adjustments, and timely communication with providers and clinical teams.

Monitor provider templates and appointment availability, proactively identifying scheduling opportunities and escalating barriers that may impact patient access.

Coordinate appointments for VIP patients as needed, ensuring timely communication and appropriate follow-up.

Maintain accurate clinical scheduling records and ensure scheduling information is organized, accessible, and communicated to appropriate stakeholders.

Patient Escalations

Receive, review, and coordinate patient-related escalations, ensuring timely communication, appropriate follow-up, and resolution.

Track outstanding patient escalations, monitor resolution status, and escalate complex or unresolved matters to clinical leadership as appropriate.

Medical Records, Imaging, and Fax Management

Coordinate the receipt, review, processing, and uploading of external patient medical records into Epic/UChart.

Facilitate the uploading of patient imaging CDs into the appropriate imaging systems to ensure availability for provider review.

Verify that medical records, imaging, and supporting documentation are accurately associated with the appropriate patient chart.

Assist providers and clinical teams with obtaining outside medical records, imaging studies, and additional documentation necessary for patient appointments.

Monitor and manage incoming and outgoing departmental faxes, ensuring timely review, distribution, and appropriate routing to providers and clinical teams.

Upload and index faxed documentation into patient medical records and follow up on missing or incomplete information.

Maintain patient confidentiality and ensure compliance with HIPAA, University policies, and departmental documentation standards.

Prior Authorizations and Insurance Coordination

Coordinate and support prior authorization requests for medications, diagnostic testing, procedures, and other clinical services to ensure timely patient access to care.

Verify insurance requirements and determine authorization needs for scheduled services.

Submit, monitor, and follow up on prior authorization requests with insurance companies and appropriate internal departments.

Collaborate with providers, clinical staff, and authorization teams to obtain required clinical documentation and resolve authorization-related barriers.

Monitor pending authorizations, communicate approval or denial status, and escalate delays that may impact patient care or scheduled appointments.

Assist with coordinating peer-to-peer reviews, appeals, and additional documentation requests as needed.

Maintain accurate authorization records and documentation in Epic/UChart and other applicable systems.

Clinic Operations and Room Management

Coordinate and maintain daily clinic room assignments to support efficient utilization of clinical space and resources.

Manage provider room requests, room availability, and scheduling adjustments based on operational needs.

Maintain and update the clinic room master schedule, ensuring accurate communication of room assignments and changes.

Collaborate with clinical leadership, providers, and administrative teams to resolve room scheduling conflicts and accommodate changing clinical needs.

Identify opportunities to improve clinic space utilization, operational workflows, and resource allocation.

Provider Scheduling and Operational Support

Create, update, and distribute physician on-call calendars, including Stroke coverage for Jackson Memorial Hospital and UHealth Tower, as assigned.

Maintain communication with hospital and outpatient clinical staff to optimize physician schedules and coordinate clinical activities.

Communicate regularly with division leadership, providers, and clinical operations staff regarding scheduling changes, patient appointments, and operational needs.

Assist with procedure and medication authorization workflows, including submission, follow-up, and coordination with appropriate authorization teams.

Maintain historical scheduling records, operational databases, reports, and documentation to support departmental needs.

Provide cross-coverage and administrative assistance to other departmental staff as needed to ensure continuity of operations.

Departmental Support and Process Improvement

Support departmental initiatives, workflow improvements, and special projects aimed at enhancing operational efficiency and patient access.

Maintain accurate administrative records, databases, and reports to support departmental operations.

Perform other related duties as assigned to support the operational and administrative needs of the Department of Neurology.

This list of duties and responsibilities is not