at SIU Medicine in Springfield, Illinois, United States
Job Description
Description
The function of this position examines and analyzes explanation of benefits to determined if correct payment has been made or to determine how to receive maximum benefits from the third party payer. The incumbent routinely reviews outstanding invoices to determine action steps needed to resolve the balance. The incumbent processes various types of moderately complex insurance claim forms and is also responsible for taking the necessary action to complete claim forms and coordinate benefits between third arty payers.
Examples of Duties
70% Invoice Follow-up:
Reviews explanation of benefits (eob) for denials.
Access patient account in the Centricity Business billing system.
Determine action needed and proceed appropriately.
Bill secondary insurance when appropriate.
Transfer denied charge to patient or another responsible party as needed.
Order medical notes when needed.
Submit denial information to the medical coding staff in the clinical departments for review and coding decisions.
Track requests for coding review. Resubmit claims based on the coding reviewer response or take write-offs as directed.
Review charges that are paid to determine if further review is necessary.
Process appropriate adjustment/ write off for denied charges that do not need medical coding review (non-covered service, untimely filings, etc.)
Retrieves eobs from CD rom, microfilm or other hard copy records and files as needed.
Make appropriate entry of actions taken in the billing system modules.
Open, print and close batch proof; balance after daily use.
Able to make complex decisions when resolving accounts, and work independently.
15% Insurance Follow-up:
Contact Insurance company representatives to discuss denials and zero pays.
Able to make complex decisions when resolving accounts, take appropriate action steps including resubmission, adjustments, request for review, etc.
Forward to immediate supervisor or manager if necessary.
Request telephone reviews of claims if appropriate.
Make appropriate entry of actions taken in the billing system modules.
I 0% Correspondence:
Opens and reviews incoming mail related to the payer teame. Responds to complex correspondence as needed or as instructed by the Insurance Assistant Manager.
5% Other duties as assigned. Maintain personal Procedure Manual with current procedures for reference.
Qualifications
Any one or combination totaling one (1) year (12 months) from the categories below:
College coursework in a health-related field, business administration/management, human resource management, or closely related fields as measured by the following conversion table or its proportional equivalent:
30 semester hours equals one (1) year (12 months)
Associate's Degree (60 semester hours) equals eighteen months (18 months)
Work experience in a healthcare environment working with medical claims, denials, rejections, referrals, and prior authorizations.
Supplemental Information
If you require assistance, please contact the Office of Human Resources at or call 217-545-0223 Monday through Friday, 8:00am-4:30pm.
The mission of Southern Illinois University School of Medicine is to optimize the health of the people of central and southern Illinois through education, patient care, research and service to the community.
The SIU School of Medicine Annual Security Report is available online at . This report contains policy statements and crime statistics for Southern Illinois University School of Medicine in Springfield, IL. This report is published in compliance with Federal Law titled the
"Jeanne Clery Disclosure of Campus Security Policy and Crime Statistics Act."
Southern Illinois University School of Medicine is an Affirmative Action/Equal Opportunity employer who provides equal employment and educational opportunities for all qualified persons without regard to race, color, religion, sex, national origin, age, disability, sexual orientation, protected veteran status or marital status in accordance with local, state and federal law.
Pre-employment background screenings required.
Southern Illinois University School of Medicine is an Equal Opportunity Employer.
