at SIU Medicine in Springfield, Illinois, United States
Job Description
Description
This person will serve as an Assistant Manager of the denials processes within the Department of Surgery, Monitoring Insurance representative, associates and specialist within the Department and will orientate new staff, and serve as a resource to all staff, residents, physicians and nurses in the Department of surgery. This person will be responsible for all aspects of denials, appeals and missing preauthorization's/pre-certifications of patient procedures for the Department of Surgery. This position will be responsible for updating maintaining a departmental managed care manual as well as updating faculty and staff within the department of changes in the managed care process. This person will interact with physicians, nurses and supportive staff within the Department of surgery, as well as insurance companies, and outside facilities.
Examples of Duties
selects, trains, and supervises staff members; evaluates the work performance of staff and takes the appropriate disciplinary action as required;
develops, implements, interprets, revises, and enforces unit policies and procedures and assists with contracting or drafting benefits of the insurance plan(s);
determines the procedures that are to be followed in atypical circumstances;
responsible for implementing the compliance operations with all required accounting and auditing procedures, either through personal performance or the supervision of assigned staff;
advises and consults with campus personnel or other relevant individuals about policies related to medical insurance;
determines the adequacy of processing procedures;
responsible for the maintenance of records or record systems;
prepares reports as required;
corresponds with or makes direct calls regarding problem claims (i.e., responds to appeals);
performs duties consistent with the lower levels of the series;
performs other related duties as assigned.
Qualifications
Any one or combination totaling five (5) years (60 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)
Bachelor?s Degree (120 semester hours) equals three (3) years (36 months)
Progressively more responsible 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 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.
