Medical Insurance Associate (U)

at SIU Medicine in Springfield, Illinois, United States

Job Description

Description
This person will be responsible for preauthorization/precertification denials within the Department of Surgery. This person will maintain a departmental managed care manual as well as updating faculty and staff in the Department regarding changes in the managed care process. This person will interact with physicians, residents, nurses and secretarial staff in the Department as well as insurance companies, patients and other departments or clinical areas.
 Examples of Duties
1. Preauthorization /Precertification/Predetermination 85%
A. Ensures all planned services, complex cases included, are appropriately
preauthorized/precertified to secure the accurate billing process of patient procedure (e.g. diagnostic tests, inpatient and outpatient surgery, rehab, and DME's). This involves discussion with the physician or nurse, reviewing the patient's medical record for necessary documentation and disseminating the appropriate information to the managed care/insurance company in order to secure reimbursement services. Resubmitting denied claims and or corrected billing information on
non-complex denials.
B. Provide Faculty and staff with updates regarding changes made to managed care/insurance
procedures and or protocols.
C. Maintains a central resource manual of managed care/insurance plans
D. Respond to ALL inquiries from physicians, nurses, hospitals, government agencies,
insurance companies, managed care companies and patients concerning requests for assistance to
assure appropriate coverage for planned medical services
E. Receive and respond to all patient calls regarding insurance denial questions, percerts,
authorization denials
F. Identifies, analyzes and takes necessary action in the review of insurance denials in order to
determine the appropriate course of action required to accurately complete the medical review
process.
G. Secure additional health information from the patient and/or physician regarding the episode of
care being denied and initiates follow-up discussions with insurance organizations in order to
obtain medical review
H. Correspond with physicians, nurses, hospitals, governments agencies, insurance companies,
managed care companies and patients as required to identify and collect the information required to
complete the authorization process
I. Obtain all required Codes for proposed services utilizing CPT coding books after chart review
and/or discussion with physician or nurse and disseminate to the certifying agency.
J. Attend monthly coding meetings for Department2.Administrative 15%

A. Attend training sessions, meetings and conferences and read publication to remain current on the
policies and procedures of managed care/insurance companies.
B. Participate in SIU Physicians & Surgeons committees as requested.
C. Other duties/projects 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.