Medical Insurance Associate (U)

The function of this position examines and analyz.es 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.

70% Invoice Follow-up:
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 decis ions. 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 eobs 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% Insurance Follow-up:
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% Correspondence:
Opens and reviews incoming mail related to the payer teame. 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.

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.

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.

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"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.