at SIU Medicine in Springfield, Illinois, United States
Job Description
Description
Under general supervision, the Medical Insurance Associate independently submits or takes the necessary actions to complete or process routine insurance claim/medical claim forms, referrals, and prior authorizations. They are also responsible for completing or processing moderately complex claim/medical forms, coordinating benefits between two or more third-party payers, and collecting outstanding payments. Employees at this level may train lower-level staff members.
Examples of Duties
takes the necessary action to complete, bill, collect or adjudicate moderately complex medical claims;
schedules internal referral appointments in the billing system per protocol;
posts and adjusts the benefits or financial files for persons utilizing the program;
interprets standard, established codes provided by the various agencies or healthcare providers and adjudicates procedures according to these interpretations;
reviews and analyzes itemized bills or claim forms for consistency and investigates discrepancies to determine the appropriate course of action required to complete the adjudication or billing process accurately;
trains Medical Insurance Representative and related support staff;
serves as a liaison between insurance and providers to ensure coverage and benefits before treatment, act as a patient advocate in securing and scheduling referrals, pre-authorizations, or pre-certifications;
assists in counseling patients, students, and parents about plan eligibility, benefits, and enrollment;
collects, reviews, and analyzes payment, capitation, adjustment, or denial records, and posts or adjusts records as required;
reviews billing data for accuracy and/or completeness and make the necessary corrections;
performs duties consistent with lower-level of series;
performs other related duties as assigned.
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 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.
