Medical Insurance Associate (U) (4582)

SIU Medicine; Springfield (IL); On-site; USD 42,000 - 62,000; Full time

Job summary

SIU Medicine in Springfield, IL seeks a on-site Billing Specialist to examine and analyze explanations of benefits. You will review outstanding invoices, determine action steps, and resolve balances with third-party payers.

The role focuses on denials, referrals, and prior authorizations, with daily entry in the billing system and coordination with medical coding staff to optimize payments.

Qualifications

• One year (12 months) of healthcare claims experience or coursework.
• Familiarity with denials, rejections, referrals, and prior authorizations.
• Ability to review explanation of benefits (EOB) and determine action steps.
• Knowledge of medical terminology and hospital or physician billing.

Responsibilities

• Review EOBs for denials and determine actions.
• Access Centricity Business to review patient accounts.
• Determine steps and resubmit/adjust claims as needed.
• Bill secondary insurance when appropriate.
• Transfer denied charges to patients or responsible parties.
• Maintain documentation and balance batches daily.

Skills

Customer service

English grammar

Medical terminology

Arithmetic skills

Computer skills

Attention to detail

HIPAA compliance

Patient communication

Training others

Education

Health-related college coursework

Associate's Degree

Tools

Centricity Business

Job description

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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

70%
Reviews explanation of benefits (EOB) for denials
Access patient account in the Centricity Business 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 medical notes when needed.
Submit denial information to the medical coding staff in the clinical departments for review and coding decisions. Track requests for coding review. 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 EOB's from CD rom, microfilm or other 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.
15%
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.
10%
Opens and reviews incoming mail related to the payer team. Responds to complex correspondence as needed or as instructed by the Insurance Assistant Manager.
5%
Other duties as assigned. Maintain personal Procedure Manual with current procedures for reference

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)
      • Associate's 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 (KSA's):

1. Knowledge of principles and processes for providing customer and personal services. This includes customer needs assessment, meeting quality standards for services, and evaluating customer satisfaction.
2. Knowledge of the structure and content of the English language including the meaning and spelling of words, rules of composition, and grammar.
3. Knowledge of medical terminology and hospital or physician billing, coding, referrals, and prior authorizations.
4. Knowledge of basic arithmetic with the ability to add, subtract, multiply and divide whole numbers, decimals and percentages.
5. Skill in using computers and computer systems (including hardware and software) to program, write, set up functions, enter data, or process information.
6. Ability to pay close attention to details and follow established procedures in completing work tasks.
7. Ability to maintain patient confidentiality following HIPAA guidelines and established policies and procedures.
8. Ability to convey moderately complex billing, claims, referral, and prior authorization information to patients and staff.
9. Ability to train others to work collaboratively, building strategic relations with colleagues, coworkers, constituents.

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 [e-mail] 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.