Medical Insurance Associate U Job Springfield area,Illinois USA,Healthcare

Position: Medical Insurance Associate - (U) - (4582)

Description

The primary function is to verify patient demographic information, insurance eligibility, and handle managed care referrals and pre‑authorizations for SIU Medicine. Under general supervision, the Medical Insurance Representative submits or takes the necessary actions to complete or process various types of routine and moderately complex insurance claim/medical claim forms. They are also responsible for duties related to insurance verification, serving as an insurance liaison, securing referrals to specialty physicians, health‑care agencies, outpatient testing and other services.

They coordinate benefits between two or more third‑party payers and collect outstanding payments.

* This position is ON SITE only.*

Examples of Duties

Managed Care - 95%

Initiates and completes all types of managed care referrals/pre‑authorizations at the direction of the patient's physician to secure approval for ongoing medical care.

Schedules outpatient and inpatient testing with off‑site locations.

Enters orders/referrals in the practice management system and links to the appropriate appointment.

Reviews patient medical records for necessary documentation and disseminates the appropriate information to insurance companies to secure precertification approval.

Responds to questions from clinical staff, physicians and patients concerning proper actions to retain authorizations/pre‑certifications.

Secures additional health information from the patient and/or physician office regarding the episode of care denied; initiates follow‑up discussions with managed care organizations to review referrals for medical care.

Corresponds with and responds to inquiries from healthcare providers, patients, or plan members, insurance companies, government agencies, and persons utilizing the program/plans to identify and collect information required to complete necessary forms or medical claims for reimbursement.

Reports and resolves third‑party denials under indirect guidance from the supervisor.

Acts as a liaison among patients, physicians, hospitals, insurance companies, and related parties regarding the disposition of problem claim reimbursements due to precertification issues.

Miscellaneous - 5%

Other duties as assigned.

Qualifications

Credentials to be Verified by Placement Officer

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. Conversion table:
- 30 semester hours = one (1) year (12 months)
- Associate's Degree (60 semester hours) = eighteen months (18 months)
Work experience in a healthcare environment working with medical claims, denials, rejections, referrals, and prior authorizations.

Knowledge,

Skills and Abilities

(KSA’s)

Knowledge of principles and processes for providing customer and personal services, including needs assessment and quality standards.

Knowledge of the English language structure, meaning, spelling, composition rules, and grammar.

Knowledge of medical terminology and hospital/physician billing, coding, referrals, and prior authorizations.

Knowledge of basic arithmetic and ability to perform calculations with whole numbers, decimals, and percentages.

Skill in using computers and computer systems to program, write, set up functions, enter data, or process information.

Attention to detail and adherence to established procedures.

Ability to maintain patient confidentiality following HIPAA guidelines and established policies and procedures.

Ability to convey moderately complex billing, claims, referral, and prior authorization information to patients and staff.

Ability to train others collaboratively and build strategic relations with colleagues and constituents.

Condition of Employment

Pursuant to the State Universities Civil Service System, an out‑of‑state resident hired into this position must establish Illinois residency within 180 calendar days of the start date.

Supplemental Information

If you require assistance, please contact the Office of Human Resources at hr recruitment or call Monday through Friday, 8:00am-4:30pm.

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.

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