Now Hiring - University of Miami - Education QA Supervisor, Patient Access (Call Center) in Miami, FL

Full description of the position

General Description (Purpose and Function):

Responsible for managing the assigned clinic location(s) day-to-day functions related to On-site Patient Access and

Ancillary/Clinic Support Services for both POS 11 and 22 multi-specialty clinics, and hospital departments across the

UHealth system. This position supports UHealth’s vision, mission, goals and objectives by providing efficient patient

centric on-site patient access and ancillary/clinical support services and demonstrating a commitment to service

excellence.

PRIMARY DUTIES AND RESPONSIBILITIES:

1. Commitment to Service Excellence

Serve as Patient Advocate and Service Ambassador by providing a favorable first impression and

proactive attention to internal and external customers in order to meet or exceed expectations, address

concerns, and optimize experience.

• Project a professional appearance and demeanor including appropriate body language and vocal tone.

• Immediately recognize and acknowledge internal and external customers in a welcoming, courteous and

professional manner.

• Respect the privacy, dignity and confidentiality of our patients and be responsive to their needs by showing

concern, empathy, patience and respect.

• Maintain composure during stressful situations and use sound judgment.

• Provide immediate service recovery by taking ownership of any problems that may arise and resolving them

utilizing appropriate rationale.

• Provide patients with and interpret Patient Rights and Responsibilities.

• Reduce patient and family stress and increase patient satisfaction by actively participating in providing the

best possible patient experience.

2. Management

Responsible for the supervision of the daily activities of the On-site Patient Access personnel.

• Ensures that all patients, customers, visitors, and staff are well served by providing a pleasant and organized

atmosphere of operations that is appropriate for the requirements of all age groups, ethnic groups and

physical handicaps.

Job descriptions are not intended, and should not be construed to be an exhaustive lists of all responsibilities, skills, and efforts or working conditions

associated with a job. Management reserves the right to revise duties as needed.

• Assists Clinic Manager with the management functions of planning, organizing, controlling, and scheduling

for the daily expected volumes, including the efficient and cost effective management of the clinic registration

area.

• Ensures all staff members adhere to all established policies and procedures related to the front desk

business operations and continuously monitors compliance.

• Monitors patient flow and communicates to Clinic Manager of any issues, including wait times, in the

registration and clinical areas throughout the day.

• Seeks feedback from physicians, and business operations staff on a daily basis in an effort to assist the

Clinic Manager in identifying performance improvement initiatives.

• Provides needed coverage to other clinics, and ER as volumes dictate employing team collaboration and

spirit.

• Motivates employees through the use of positive reinforcement and recognition of employee problems with

efforts to resolve these problems.

• Assists in monitoring staff productivity and quality of work through proactive reviews of attendance, data

entry, bypass warnings, past due balance collection, copay collection, charge entry - voucher organization,

scheduling accuracy, patient satisfaction scores, etc.

• Complete employee time records in the Kronos System.

• Performs year end evaluations and new hire 90-evaluations.

3. Scheduling

Coordinate scheduling of all walk in, add on, and follow up appointments in accordance with established

guidelines and in multiple systems, i.e. UChart Cadence/Prelude/Enterprise Billing, UMCare, and

RIS/PAC.

• Enter and/or update all pertinent data including demographics, financial, and referring physician information.

• Interact with patients and collaborate with providers and clinicians to appropriately schedule appointments

taking into account scheduling guidelines per division/specialty/provider, resource availability, special needs,

timeframes, medical necessity, and payer and contractual guidelines.

• Determine appointment type and utilize analytical skills to determine appropriate slot utilization and instances

when overbooking is appropriate.

• Obtain and document pertinent insurance verification information (i.e. CPT codes, service description, reason

for visit, etc.) needed to obtain authorization/pre-cert in order to avoid denials and ensure financial

reimbursement.

• Coordinate multiple appointments with appropriate sequence and proper time allotted between

appointments.

• Communicate to patient the place of service where each appointment will take place (i.e. POS 11 vs. 22) and

how it may impact his/her financial responsibility.

4. Ancillary/Clinic Support Services

Perform ancillary/clinic support duties which vary by hospital departments and specialties (i.e. ER,

Admitting, CTU, Imaging, Bariatrics, Dermatology, Infertility, Mental Health, OB GYN, Oral Surgery,

Pediatrics, Plastic Surgery, etc.) that include but are not limited to the following:

• UChart Office Assistant functions and monitoring of Provider’s In Basket Messaging

Job descriptions are not intended, and should not be construed to be an exhaustive lists of all responsibilities, skills, and efforts or working conditions

associated with a job. Management reserves the right to revise duties as needed.

• Processing of Back to Work or School Requests, and Immunization Records

• Scanning Imaging Results

• Preparing Charts/Medical Records

• Processing of Medical Record Release of Information

• Prescription Refill Requests

• Test Results Requests

• Medication Inventory

• Treatment Plans

• Appt. Reminder Calls

• Bump Lists

• Surgery Scheduling

• Coordination of External Referrals

• Promotion and Sales of Over the Counter Products

• Inventory and Ordering of Supplies

• Ordering of DME products

• Bed Assignments

• Pre-certifications

5. On-site Registration (Check in/Admission)

Perform all on-site patient access registration related functions promptly without compromising patient

safety, quality, service levels, and reimbursement.

• Obtain legal photo identification and (if applicable) insurance card (s), and validate patient identity and

coverage (if applicable) prior to services being rendered thereby ensuring patient safety and financial

reimbursement.

• Scan ID, insurance card (s), advance directives, share of cost letters, and any other pertinent documents.

• Obtain and/or verify that all demographic, financial, and insurance coverage information is accurate, up to

date and complete, and that financial clearance has been obtained inclusive of all required

referrals/authorizations.

• Explain all applicable forms (i.e. Consent for Medical Treatment and Conditions of Admission,

Acknowledgement of Receipt of Privacy Practices, Questionnaires, Important Message from Medicare,

Advance Directives Checklist, and answer any questions patients’ may have pertaining to form(s) and

established policies.

• Obtain and witness all patient/guarantor signatures on all applicable consents and forms, and ensure that all

initial and signature areas required have been completed and forms have been dated, timed and labeled.

• Print out labels and/or any forms required by treatment area.

• Complete check-in and registration process as rapidly as possible (without compromising quality or service

level) in order to minimize the time patients must wait for treatment to begin.

6. Insurance Verification/Financial Clearance

Verify insurance eligibility, obtain all applicable referrals/authorizations/pre-certifications, and confirm

that non-emergent visits have been financially cleared prior to services being rendered in order to ensure

financial reimbursement.

Job descriptions are not intended, and should not be construed to be an exhaustive lists of all responsibilities, skills, and efforts or working conditions

associated with a job. Management reserves the right to revise duties as needed.

• Verify insurance eligibility and authorization requirements for walk-ins and add-ons utilizing multiple

automated on-line resources or telephone.

• Identify point of service (POS) 11 versus 22 and obtain verification and referral/authorization accordingly.

• Provide patient/guarantor with detailed benefit and authorization requirements and co-pay, deductible, and

co-insurance self–pay responsibility for POS 11 and 22.

• Ensure that the appropriate payer has been selected (i.e. Indemnity, HMO, PPO, POS, Auto, W/C, etc.) and

that all the required data elements and referrals and authorizations based on CPT, ICD 9, and services being

rendered have been obtained and accurately entered in system in order to avoid claim rejections.

• Refer non-contracted payers for single case negotiation.

• Determine appropriate filing order if patient is covered by more than (1) payer.

• Financially clear visits once insurance has been verified and referral/authorizations obtained.

• Generate HAR (Hospital Account Record) for all services rendered at a point of service 22 (POS 22), and

assigns HAR’s to appointments accordingly.

.

7. Compliance

Comply and abide with all established UHealth policies and procedures related to Patient Access and

State/ Federal regulations.

MSPQ

• Complete the Medicare Secondary Payer Questionnaire (MSPQ) at time of scheduling prior to services

being rendered and in accordance with Centers for Medicare & Medicaid Services (CMS) Federal

regulations.

ABN

• Utilize medical necessity software to determine if an Advance Beneficiary Notice (ABN) is applicable in

order to produce and provide all Medicare patients with an ABN in accordance with CMS Federal

regulations prior to services being rendered. Explain ABN in detail and allow patient to make an informed

decision and document in system.

Study and Transplant

• Identify patients enrolled in a Study/Transplant program and validate that the account reflects the appropriate

coverage(s) as it relates to the Study/Transplant program, in order to ensure accurate billing.

8. Collections

Identify and collect patient’s self-pay responsibility including co-pays, deductibles, co-insurances, self pay discount rates, global packages, and previous outstanding balances for both technical and

professional components in POS 11 and 22 clinics thereby playing a key role in reducing AR, Bad Debt,

and Collection Costs by collecting patient’s financial responsibility upfront.

• Exercise sound judgment so as not to delay treatment for emergency medical conditions and necessary

stabilizing treatments, due to patient’s financial responsibility and collection efforts.

• Determine and collect patient’s estimated financial responsibility for both POS 22 and POS 11 (i.e.

deductible, co-payment, co-insurance, prompt payment discounts or global fee based on CPT/ICD9 codes).

• Explain charges, fees, and previous balances for both technical and professional components.

Job descriptions are not intended, and should not be construed to be an exhaustive lists of all responsibilities, skills, and efforts or working conditions

associated with a job. Management reserves the right to revise duties as needed.

• Offer forms of payment including cash, checks, and credit cards.

• Check for counterfeit bills when collecting cash and obtain authorization for all credit card transactions.

• Post payment(s) as applicable for both POS 11 and 22, and issue system generated receipt(s).

• Reconcile all collections and transactions at the end of the shift including initial cash bag funds.

• Prepare daily deposit(s) for Med Finance, Main Cashier, or contracted armored pick up service.

• Document any and all collection details including discounts, global fees and partial payments in system and

select applicable billing indicators and FYI Global/Discount flags.

9. Financial Counseling

Provide upfront financial counseling services at time of check-in including identifying alternate funding

resources, and establishing payment plans.

• Advise patients of financial obligations and collect according to established guidelines and financial policies.

• Identify alternate funding sources and offer global or discount.

• Identify patients which have been deemed eligible for charity care or financial hardship and determine if

services being rendered are encompassed in charity approval.

• Assist patients in establishing payment plans.

10. Discharge / Departure

Coordinate discharge process including identification and collection of additional self-pay charges,

prompt scheduling of all follow up appointments, procedures, diagnostic testing, etc., appointment

status update, voucher/facility fee reconciliation, and After Visit Summary (AVS).

• Determine upon checkout/discharge any pending financial responsibility, and collect and post payment(s)

accordingly.

• Systematically reflect the checkout/discharge status by carrying out the checkout function and updating the

appointment status to complete.

• Check discharge orders and coordinate the prompt scheduling of any and all follow up

appointment(s)/procedure(s), diagnostic or ancillary services ordered.

• Print and provide the patient with an After Visit Summary (AVS).

• Obtain applicable vouchers, facility fee, and/or secondary forms and screen for accuracy.

11. Front End Revenue Cycle Quality Control

Comply with all standard operating procedures established to support key metrics and quality assurance

initiatives that contribute toward prompt billing and increased cash flow.

• Identify systematic warning flags/messages and populate required data elements in order to eliminate by passed warnings/errors and avoid a negative impact on downstream revenue cycle processes.

• Monitor and clear patient work queues on a daily basis to ensure data integrity, prompt billing and minimal

AR days.

• Populate any and all required data to ensure the checklist at the end of the arrival process reflects as

complete for each category.

Job descriptions are not intended, and should not be construed to be an exhaustive lists of all responsibilities, skills, and efforts or working conditions

associated with a job. Management reserves the right to revise duties as needed.

12. Charge Entry

Account for and enter accurate charges within established time frame.

• Enter charge codes and amount of units accurately and within (1) business day of services being rendered.

• Perform daily reconciliation to identify missing charges and follow up with clinicians to obtain in order to

ensure all rendered services are accounted for and billed.

• Maintain a 3 calendar day maximum lag in order to ensure prompt billing and increased cash flow.

13. End of Day (EOD)

Perform end of day duties to ensure the accuracy of all appointment/visit statuses in system.

• Review DAR and identify appointments that are not in completed status

• Contact clinicians to confirm appropriate status of each appointment.

• Update status accordingly (i.e. no-show, left without being seen, canceled, etc.).

14. Other Duties

Perform other duties as assigned based on departmental needs.

Knowledge, Skills, and Abilities:

• Excellent verbal and written communications skills in English. Bi-Lingual (English/Spanish, English/Creole,

English/French, English/Arabic) a plus.

• Must possess excellent, critical thinking, analytical, troubleshooting, problem resolution, and customer

service skills.

• Excellent mathematical and cash management skills.

• Must be able to function independently and exercise sound judgment in making decisions consistent with

departmental guidelines/objectives.

• Ability to handle multiple tasks simultaneously and float to multiple areas as needed

• Punctuality, attendance, and flexibility essential in order to meet departmental needs and ensure appropriate

clinic flow.

• Excellent interpersonal skills and ability to work effectively with physicians, co-workers, other departments

and patients of all ages, and from across a broad range of cultural and social economic backgrounds.

• Knowledge of medical terminology preferred.

• Ability to work as an integral team member under minimal supervision, in a fast-paced, complex and highly

stressful environment

• Ability to coordinate, prioritize, and organize work and patient flow.

• Ability to show tolerance and sensitivity in stressful situations and safeguard confidential information in

accordance with established policies and HIPAA laws.

• Computer literate and ability to use multiple systems and acquire proficiency in the following electronic

systems: UChart Cadence/Prelude/Enterprise Billing, Passport HealthWorks Compliance Checker, Availity,

RIS-PACS, CaneCare, UMCare, Intellidose, MCSL, Experian and all online verification systems used by

contracted payors.

Job descriptions are not intended, and should not be construed to be an exhaustive lists of all responsibilities, skills, and efforts or working conditions

associated with a job. Management reserves the right to revise duties as needed.

Education Requirements (Essential Requirements):

• High School Diploma required.

• Bachelor’s degree preferred.

Work Experience Requirements (Essential Requirements):

• Five (5) years of experience in a healthcare related setting. Consideration will be given to an appropriate

combination of education/training, and proven experience

Job Type: Full-time

Pay: From $46,000.00 per year

Benefits:

• 401(k)
• Dental insurance
• Employee assistance program
• Employee discount
• Flexible spending account
• Health insurance
• Life insurance
• Paid time off
• Parental leave
• Retirement plan
• Tuition reimbursement
• Vision insurance

Healthcare setting:

• Clinic
• Outpatient
• Telehealth

Schedule:

• Monday to Friday
• On call
• Weekends as needed

Ability to commute/relocate:

• Miami, FL 33136: Reliably commute or planning to relocate before starting work (Required)

Application Question(s):

• Do you have experience in pulling data and providing analytics?

Experience:

• Call center management: 1 year (Required)

Language:

• Spanish and English (Required)

Work Location: In person