Surgery Services Representative

The University of Miami, Bascom Palmer Eye Institute, has an exciting full time opportunity for a Lead Surgery Services Representative in the Department of Patient Access in Miami, Florida.

The Lead Surgery Services Representative (H) coordinates a wide range of complex surgery scheduling and front-end revenue cycle clinic functions that impact the patient experience, surgical volume, and revenue. The incumbent serves as functional expert for department peers and oversees team adherence with established policies and procedures.

CORE JOB FUNCTIONS                                                                                           

• Obtains, confirms, and enters demographic, financial, and clinical information necessary for financial clearance of scheduled patient accounts.

• Monitors cancellations to maintain schedules and quickly identify and fill cancelled slots to mitigate decreased provider productivity and loss of revenue.

• Contacts patients’ families or physicians’ offices to obtain missing insurance information.

• Verifies insurance and confirms insurance eligibility of patient coverage benefits, notifying patient and referring physician in the event of failed eligibility.

• Creates a patient identification band for each patient in accordance with patient safety and risk management protocols and validates information when placing the band.

• Collaborates with scheduling departments to identify add-on patients.

• Creates estimates for both hospital and professional fees.

• Obtains necessary authorizations, pre-certifications, and referrals.

• Notifies patients of liabilities prior to date of service and collects funds.

• Maintains appropriate records, files, and accurate documentation in the system of record.

• Serves as a lead resource for lower-level Patient Services staff and assists with training.

• Recommends new approaches to management for enhancing performance and productivity.

• Deploys critical thinking while responding to a variety of technical issues from patients, physicians and employees via phone, email, web messages, fax, or email.

• Works independently and deals effectively with stress, due to heavy workload and the handling of complex patient inquiries.

• Serves as a role model, facilitator, and coach in developing a culture of compassion and caring through building healthy relationships among staff, patients, and families.

• Projects a professional appearance and pleasant demeanor creating a welcoming atmosphere.

• 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 required

Certification and Licensing:

Not Applicable

Experience:

Minimum 3 years of relevant experience

Knowledge, Skills and Attitudes:

• Skilled in data entry and completing assignments accurately and with attention to detail.

• Skilled in prioritizing and organizing tasks.

• Ability to communicate effectively in both oral and written form.

• Ability to process and handle confidential information with discretion.

• Ability to work independently and/or in a collaborative environment.

• Ability to analyze, organize and prioritize work under pressure while meeting multiple deadlines.

• Ability to handle multiple tasks, software systems, and technologies simultaneously.

• Ability to establish and maintain effective working relationships with patients and staff.

• Knowledge of generally accepted accounting procedures and principles.

• Works well under unstructured work environments/processes. 

• Flexible with shifts on day-to-day tasks and responsibilities.

• Able to switch rapidly between different tasks effectively.

• Adaptable to new responsibilities.

• Handles distractions well.

• Manage large call volume daily 30+ calls

• Proficiency in computer software (i.e. Microsoft Office).

Department Specific Functions

• 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 resource to Surgery Services Representatives and assists with training and supervision.