Medical Insurance Representative- Decatur (4581)

This position serves as referral and preauthorization representative for the SIU Center for Family Medicine Decatur. Responsibilities include serving as liaison with specialist offices, insurance companies, and ancillary services (eg, lab, radiology, CT, MRI, major procedures) by assisting in the care patients receive among the different providers. This position fosters a team approach by working collaboratively with the patient, family, physician, and other members of the health care team to ensure services are provided in an efficient and effective manner. Actively participates in provider and staff team projects in order to enhance patient satisfaction.

95% Referral/Pre-Authorization Assistance
1. Maintains patient medical records in accordance to policy.
2. Assists in completing patient referrals and preauthorizations:
a) Assists patients with securing referrals to specialist physicians, health care agencies, and hospitals.
b) Works with managed care organizations and the physician's office, providing appropriate documentation for referrals, authorizations for hospital, testing or other services.
c) Responsible for determining and disseminating the required information from the patient's medical records, i.e., chart notes, school physicals, laboratory results, x-rays, etc., to assure the medical necessity of the request to the consultant, and/or insurance/managed care company
d) Helps to maintain up-to-date directory of services provided to SIU Center for Family Medicine - Decatur patients by specialists and health care agencies.
e) Contacts managed care companies concerning status of referrals and preauthorizations.
f) Keeps faculty physicians, resident physicians, nurse practitioners, physician assistants, nurses and other staff at the clinic informed about the requirements and medical necessity guidelines of managed care referrals and authorization requests.
g) Helps to maintain log of health care agency addresses and telephone numbers by specialty area.
h) Maintains the ability to appropriately handle referrals, schedule appointments, answer general patient questions; knowledgeable about procedures and services.
i) Helps to monitor referral reports, and assists with timely follow-up in accordance with policy and procedure.
j) Enters referral and preauthorization information into the electronic medical records and computer system according to policy and procedure.
3.Maintains operating knowledge of the following systems IDX, TouchWorks, MEDI, and Cerner.

5% Other
1. Provides feedback regarding the development of appropriate forms for internal and external use as it relates to referrals and preauthorization's.
2. Participate in staff meetings and in SIU committee meetings, as requested.
3. Other duties as assigned.

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.

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.