Medical Insurance Representative (U) (4581)

SIU Medicine; Springfield (IL); On-site; USD 34,000 - 42,000; Full time

Job summary

SIU Medicine in Springfield, IL seeks an entry-level Insurance Billing Clerk to examine and follow up on insurance invoices with no activity or third-party follow-ups. You will review EOBs, access Athena billing, determine next steps, and enter actions in the billing system, under supervision.

Responsibilities include contacting insurers, resubmissions, postings, and assisting with denials, credits, and patient communications, while upholding HIPAA and confidentiality in a training capacity.

Qualifications

• High school diploma or equivalent required.
• Six months of related health claims/denials experience or coursework preferred.
• Basic medical terminology and familiarity with billing concepts required.

Responsibilities

• Follow up on insurance invoices with no activity; contact insurers for claim status.
• Review EOBs for denials and apply appropriate actions in the billing system.
• Access patient accounts in Athena; record actions taken and communicate with patients as needed.

Skills

Customer service

Attention to detail

HIPAA compliance

Communication

Team collaboration

Computer skills

English grammar

Education

High school diploma or equivalent

Health-related coursework or business courses

Healthcare environment work experience

Tools

Athena billing system

Microsoft Office

Job description

We recommend using the following browsers to complete the application: Desktop: Google Chrome, Edge with Chromium. Mobile: Google Chrome, Safari.

Description

The function of this position examines and analyzes insurance invoices that have no activity or have been transferred to the insurance level for follow-up. Review explanation of benefits to determine if correct payment has been made or to determine how to receive maximum benefits from the third party payor. The incumbent routinely reviews outstanding invoices to determine action steps needed to resolve the balance. This is an entry level position which functions in a training capacity under direct supervision processing routine, non-complex medical/health claims.

Examples of Duties

Invoice Follow Up - No Activity 85%

• Contact Insurance Company for Claim Status
• Reviews Explanation Of Benefits (EOB) for denials
• Access patient account in the Athena billing system.
• Determine action needed and proceed appropriately.
• Transfer denied charge to patient or another responsible party as needed. Retrieves EOB's for submission to insurance carriers.
• Make appropriate entry of actions taken in the billing system modules.

Insurance Follow Up 10%

• Contact Insurance company representatives to discuss denials and zero pays.
• If easily resolved, take appropriate action steps including resubmission, adjustments, request for review, etc.
• Forward to immediate supervisor or manager if necessary.
• Bill secondary insurance when appropriate.
• Review charges that are paid to determine if further review is necessary.
• Order medical notes when needed
• Request telephone reviews of claims if appropriate.
• Request appropriate adjustment/write off for denied charges that do not need medical coding review (non-covered service, untimely filings, etc.)
• Make appropriate entry of actions taken in the billing system modules.

Correspondence 2%

• Responds to routine correspondence as needed.

Other Duties 3%

• Other duties as assigned

Qualifications

Credentials to be Verified by Placement Officer

1. High school diploma or equivalent.
2. Any one or combination totaling six (6) 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 six (6) months
   2. Work experience in a healthcare environment working with medical claims, denials, rejections, referrals, and/ or prior authorization.

Knowledge, Skills & 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 basic medical terminology of basic 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.
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 routine, non-complex billing, claims, referrals, and prior authorization information to patients and staff.
9. Ability 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.

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.