Clinical Business Operations Representative

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Clinical Business Operations Representative 2

The University of Miami/UHealth Department of Family Medicine and Community Health has an exciting opportunity for a Full Time, Clinical Business Operations Representative 2 to work in Miami

Core Job Summary:
The Clinical Business Operations Representative 2 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 2 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: triage 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. 

Department Specific Functions:

• Process and manage incoming and outgoing referrals for integrative medicine services.

• Obtain and track insurance authorizations, pre-certifications, and referral approvals.

• Verify eligibility, benefits, referral requirements, and authorization status prior to scheduled appointments.

• Coordinate with referring providers, insurance carriers, and external healthcare organizations to ensure timely patient access to services.

• Review patient records for completeness and obtain required documentation before consultations.

• Request, receive, and manage outside medical records, imaging, laboratory results, and supporting clinical documentation.

• Maintain accurate patient information, referrals, authorizations, and documentation within Epic.

• Support providers by managing assigned work queues, patient communications, and administrative follow-up activities.

• Coordinate follow-up appointments, diagnostic testing, and ancillary services as directed by providers.

• Communicate with patients regarding referrals, authorization status, appointment readiness, and required pre-visit information.

• Assist with insurance-related inquiries, denied services, and documentation requests to support revenue cycle processes.

• Monitor referral conversion, authorization turnaround times, and other patient access metrics to identify barriers to care.

• Support quality improvement initiatives and operational projects aimed at improving access, efficiency, and patient experience.

• Assist with departmental reporting, data collection, and performance metrics.

• Maintains compliance with HIPAA and organizational policies regarding patient confidentiality and documentation.

• Provides backup coverage for Senior Clinic Assistant responsibilities as operational needs require.

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: 

• High school diploma or equivalent

• Minimum 1 year 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.

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.

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