Victoria Jones
Fort Lauderdale,FL
Summary
Dynamic Clinical Business Operations Representative with extensive experience at University of Miami Health Systems. Expert in insurance verification and EMR systems, enhancing patient relations through effective communication. Proven ability to optimize workflows and resolve complex issues with empathy, ensuring timely prior authorizations and improved operational efficiency.
Overview
13
13
years of professional experience
Work History
Clinical Business Operations Representative
University of Miami Health Systems
Miami, Florida
04.2023 - 11.2024
- Optimized workflow efficiency by managing in-basket tasks within Epic.
- Coordinated appointment scheduling across departments to enhance patient care.
- Served as liaison with offsite testing facilities, ensuring effective communication.
- Tracked referral submissions to facilitate timely prior authorization issuance.
- Addressed patient inquiries and concerns, resolving issues with empathy.
- Completed clerical components of FMLA, parking, and LTD forms accurately.
- Fielded inquiries regarding authorization details from plan members and medical staff.
- Assisted in training and onboarding new staff to improve team performance.
- Collaborated with internal staff members to resolve discrepancies or issues related to prior authorizations.
- Reviewed prior authorization requests to ensure accuracy and completeness of required information.
- Developed relationships with external vendors providing pre-authorization services.
- Responded promptly to inquiries from providers, patients and payers regarding status of prior authorization requests.
- Reviewed claims submitted without valid pre-authorization codes and took corrective action when necessary.
- Contacted insurance companies to obtain necessary preauthorizations needed for upcoming tests and procedures.
- Identified reasons behind denied claims and worked closely with insurance carriers to promote resolutions.
Medical Receptionist /Surgery Scheduling Coordinator
Memorial Physicians Group General Surgery
Hollywood, Florida
09.2022 - 04.2023
- Managed multi-line phone system and greeted patients with professionalism.
- Resolved any discrepancies between patient records and pre-surgery documentation.
- Assisted in the scheduling of surgeries for patients, ensuring accuracy and timeliness.
- Reviewed incoming requests from physicians regarding potential surgeries, confirming that they meet eligibility criteria.
- Coordinated with medical staff to ensure that all necessary paperwork was completed prior to scheduled procedures.
- Maintained an up-to-date list of available operating rooms and equipment for surgical teams.
- Responded promptly to inquiries from patients or their families regarding upcoming surgeries.
- Worked closely with doctors' offices to coordinate patient referrals for surgery services.
- Scheduled follow-up appointments according to post-operative protocols.
- Verified patient insurance and health history for accurate information management.
- Assisted patients in completing necessary medical forms and documentation.
- Supported office staff with administrative tasks to enhance operational efficiency.
- Transcribed phone messages and relayed them to appropriate personnel promptly.
- Coordinated pre-operative and post-operative appointments for surgical patients.
- Verified insurance coverage for appointments and collected co-payments as required.
- Greeted and checked in patients, updating patient information in computer system.
- Maintained supply inventory for office area, ordering items as needed and stocking shelves.
- Answered incoming calls, responding to inquiries from patients and other medical offices.
Order Entry Specialist
FOH, Inc
Miami, Florida
01.2022 - 05.2022
- Maintained up-to-date product knowledge and inventory to address client inquiries effectively.
- Generated invoices and shipping labels to ensure accurate billing and timely shipment.
- Verified orders for accuracy, completeness, and compliance with customer specifications.
- Resolved shipping and merchandise issues while providing tracking information to customers.
- Delivered regular updates on orders to enhance transparency and build customer trust.
- Processed customer orders according to established policies and procedures.
- Monitored inventory levels to facilitate prompt order fulfillment.
Customer Solutions Specialist
Comcast
Miramar, Florida
11.2018 - 12.2021
- Processed orders and prepared correspondence for at-risk customers to prevent service cancellations.
- Addressed complaints to enhance customer satisfaction and secure renewals.
- Developed strategies to add value for new and existing customers, boosting company revenue.
- Achieved compliance with all customer call guidelines, including service levels and handling times.
Assistant
It's Just Lunch
06.2016 - 11.2018
- Answer customer inquiries
- Resolve escalated clients
- Forward messages and documents to the appropriate person and department
- Schedule , confirm and reschedule appointments.
Customer service representative
IQOR
01.2012 - 01.2015
- Collected customer feedback and made process changes to exceed customer satisfaction goals
- Made reasonable procedure exceptions to accommodate unusual customer requests
- Provided accurate and appropriate information in response to customer inquiries
- Built customer loyalty by placing follow-up calls for customers who reported product issues.
Education
High School Diploma -
Miramar High School
Miramar, FL01.2011
Skills
- Insurance verification and EMR systems
- Patient relations and records management
- HIPAA compliance and medical terminology
- Epic charting and prior authorization
- Workload prioritization and office administration
Timeline
Clinical Business Operations Representative
University of Miami Health Systems
04.2023 - 11.2024
Medical Receptionist /Surgery Scheduling Coordinator
Memorial Physicians Group General Surgery
09.2022 - 04.2023
Order Entry Specialist
FOH, Inc
01.2022 - 05.2022
Customer Solutions Specialist
Comcast
11.2018 - 12.2021
Assistant
It's Just Lunch
06.2016 - 11.2018
Customer service representative
IQOR
01.2012 - 01.2015
High School Diploma -
Miramar High School
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