at SIU Medicine in Springfield, Illinois, United States
Job Description
Description
The function of this position examines and analyzes explanation of benefits to determine if correct payment has been made or to determine how to receive maximum benefits from third party payer. The incumbent routinely reviews outstanding invoices to determine action steps needed to resolve the balance. The incumbent assist with training of new staff and assist lower level Medical Insurance staff with questions.
Examples of Duties
70% Invoice Follow-up:
Works independently and closely with Team Manager
Completes all complex task as assigned by the Team Manager
Reviews explanation of benefits ( eob) for denials
Access patient account in the Centricity Business billing system.
Determine action needed and proceed appropriately.
Responds to a variety of questions of lower level Medical Insurance staff concerning proper action needed to complete insurance claim forms.
Assist in training and evaluations of new Medical Insurance staff.
High level of knowledge and experience in reviewing complex accounts in addition to new insurance plans. 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 (noncovered service, untimely filings, etc.)
Update patient insurance information, such as correct insurance billing addresses and insurance plan effective/termination dates.
Order insurance claim forms and resubmit charges.
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.
Contact insurance companies or patients for information needed to submit claims, such as billing addresses or plan effective/termination dates.
10% 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.
10% Correspondence:
Opens and reviews incoming mail related to the payer team. 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 two (2) years (24 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)
90 semester hours equals two (2) years (24 months)
Work experience in a healthcare environment working independently with medical claims, denials, rejections, referrals, and prior authorizations.
Supplemental Information
If you require assistance, please contact the Office of Human Resources at hrrecruitment@siumed.edu 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 https://www.siumed.edu/police-security. 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.
