Vilma Ramos
Naples,Florida
Summary
Dynamic Clinical Business Operations Representative with extensive experience at the University of Miami Health System. Expert in Epic charting and patient scheduling, I excel in enhancing patient flow and communication. Proven ability to resolve issues collaboratively, contributing to increased patient visits and streamlined operations. Committed to maintaining confidentiality and delivering exceptional service.
Overview
17
17
years of professional experience
Work History
Clinical Business Operations Representative 3 (H)
University of Miami Health System
Miami, FL
01.2022 - Current
- Assists the department in managing expectations surrounding pre- and post-patient care.
- Works closely with nurse navigation to ensure all records are in place prior to the surgeon's visit.
- Obtains or reviews clinical records for completeness, including authorization, signatures, missing data, and other.
- 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.
- Reschedules all patients from PLR (Physicians Leave Requests).
- Daily calls to patients who did not show up to the clinic the prior day to reschedule. This has shown an increase in patient visits for the surgeon.
- Work disposition notes report to ensure all patients have been scheduled for visits, as indicated by the surgeon.
- Work Epic W/Q (work queues) assigned to Surgery.
- Schedule patients directly sent by our surgeons.
- Greets visitors and callers, handles their inquiries, and directs them to the appropriate persons according to their needs.
- Works cooperatively with fellow employees to solve problems and enhance the smooth and efficient flow of their practice.
- Provides coverage for the responsibilities of co-workers when assigned, or as needs arise.
- 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.
Patient Services Specialists
Cleveland Clinic Weston
Weston, Florida
12.2019 - 12.2021
- Provide a comprehensive, proactive, and 'Patients First' experience for patients and visitors.
- Investigate, triage, and resolve patient issues using the established HEART model.
- Perform patient registration, visit preparation, telephone triage, insurance verification, co-pay collection, patient and record tracking, scheduling, arrival and/or departure desk activities, and screening and scheduling of interpreter services.
- Enter and maintain confidential patient information.
- Recruit, enroll, and educate patients on MyChart and Appointment Pass.
Clinical Assistant
University of Miami Health System
Miami, FL
01.2016 - 06.2019
- Explains HIPAA to patients and obtains signatures.
- Submits signed consents to healthcare centers to initiate the retrieval of medical records, x-rays, and other pertinent reports.
- Tracks pending records to ensure delivery prior to clinic visits.
- Communicates with the appropriate nurse coordinator if it is difficult or impossible to obtain pertinent records.
- Travels within the facility and campus to retrieve records, films, or CDs.
- Collect and prepare specimens.
- Maintains accurate clinical records per hospital policy while preserving the confidentiality of patient information.
- Assembles, completes, and processes patients' charts. Processes patients' charts.
- Assists with clerical duties, including receiving phone calls, sending faxes and emails, and scanning and copying documents.
- Coordinates and obtain authorization for the patient's future appointments.
Senior Insurance Verification
University of Miami Health System
Miami, Florida
10.2008 - 01.2016
- Calls insurance companies and patients to verify insurance information.
- Obtain authorization for HMO patients.
- Verifies that claims are mailed to the proper address.
- Contact physicians, insurance companies, and/or necessary departments to obtain authorizations or referrals.
- Contact the patient to obtain additional information when necessary.
- Responds to customer inquiries regarding insurance coverage for services, and processing of claims.
- Reviews and follows up on denials, Explanation of Benefits (EOBs) received.
- Reviews patient charts, including demographic, patient/guarantor information, procedures/charges, and diagnosis codes, to verify and extract payment info.
- Obtains Medicaid, HMO, and MediPass authorizations and referrals information when necessary.
- Posts Medicaid and other third-party payments in the CMS Database system as needed.
- Inputs direct services payments into the state database for Children’s Medical Services (CMS) as needed.
- Communicates identified problems to the Supervisor, Fiscal Manager, and makes recommendations as appropriate.
Education
GED -
Robert Morgan Educational Center
18180 SW 122nd Ave, Miami, FL 3317705-1994
Skills
- Epic charting
- Patient scheduling
- Insurance verification
- Clinical documentation
- Record management
- Customer service
- Data entry
- Ability to communicate effectively and/or in a collaborative environment
- Ability to work independently and/or in a collaborative environment
- Knowledgeable about different insurance companies and how to read an Explanation of Benefits (EOBs), skilled in collecting, organizing, and analyzing data, and skilled in data entry with minimal errors
- Skill in completing assignments accurately, and with attention to detail
- Proficiency in computer software (ie, Microsoft Office)
Languages
English
Professional
Spanish
Professional
Timeline
Clinical Business Operations Representative 3 (H)
University of Miami Health System
01.2022 - Current
Patient Services Specialists
Cleveland Clinic Weston
12.2019 - 12.2021
Clinical Assistant
University of Miami Health System
01.2016 - 06.2019
Senior Insurance Verification
University of Miami Health System
10.2008 - 01.2016
GED -
Robert Morgan Educational Center
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