Medical Insurance Associate (U) (4582)

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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 the third party payer. The incumbent routinely reviews outstanding invoices to determine action steps needed to resolve the balance.

*This Position is On Site Only*

Examples of Duties

Invoice Follow Up 70%
Reviews explanation of benefits (eob) for denials
Access patient account in 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 and retrieve medical notes when needed.
Submit denial information to the medical coding staff for review and coding decisions.
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 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.

Insurance Follow Up 25%
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.
Responds to complex correspondence as needed or as instructed by the Insurance Assistant Manager.

Other Duties 5%
Performs other duties as required or assigned which are reasonably within the scope of the duties described above

Qualifications

Credentials to be Verified by Placement Officer:

1. Any one or combination totaling one (1) year (12 months) from the categories below:
   1. 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)
      • Associates Degree (60 semester hours) equals eighteen months (18 months)
   2. Work experience in a healthcare environment working with medical claims denials rejections referrals and prior authorizations.

Knowledge Skills and Abilities (KSAs):
Ability to effectively communicate with faculty staff and patients in either person or by phone.
Ability to keyboard on computer terminals.
Ability to meet established guidelines and follow policies and procedures established by the SIU Healthcare HCFA and other federal/state agencies.
Tolerance for tedious and repetitious work.
Ability to work accurately with details.
Ability and desire to greet patients/visitors in a pleasant and professional manner.
Ability to work within specific deadlines.
Ability to multitask and complete job duties amid various distractions

Condition of Employment:
Pursuant to the State Universities Civil Service System an out-of-state resident who is hired into this position must establish Illinois residency within 180 calendar days of their start date.

Supplemental Information

If you require assistance please contact the Office of Human Resources at or call 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 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 disabilitysexual orientationprotected veteran status or marital status in accordance with local state and federal law.

Pre-employment background screenings required.

Required Experience:

IC