Overview
Medical insurance assistant manager Jobs in Springfield, IL at SIU Medicine
Description
This position is responsible for oversight and coordination of the medical insurance/referral and clinical charge coding/posting functions of the Department of Obstetrics and Gynecology. This position is responsible for direct supervision of the referral, coding and posting staff. The incumbent must exercise sound judgment and work independently to ensure that billing issues from patients, physician faculty and residents, hospitals, federal and state insurance programs, managed care companies, community agencies and other parties are resolved. This position serves as facilitator for patients throughout the highly complex health care system.
Examples of Duties
Administration 45%
1. Directly supervises the OB/GYN Department Referral Staff assisting with setting daily priorities to ensure all referrals are processed in a timely manner.
2. Select, train, supervise and evaluate all clinic referral staff including disciplinary action as required.
3. Responsible for approving employee time off requests and ensuring employee time records are accurate.
4. Participates in the development and implementation of the orientation plan for new staff; assisting with training and orientation activities for all referral office staff. Provide guidance, as needed, for new team members.
5. Participates in the development of appropriate forms for internal and external use as related to referral activities.
6. Coordinates and facilitates referral staff meetings.
7. Obtains appropriate signed forms for compliance with SIU Medicine, HIPAA and insurance companies’ regulations.
8. Remains abreast of changes in the medical necessity guidelines and provides updates to staff.
9. Develops and educates providers on appropriate documentation needed for managed care plans and preauthorizations for medical services.
10. Provides guidance in all atypical situations for the referral unit.
11. Implements new procedures, policies, workflow as needed based on insurance
changes/departmental needs, software changes and upgrades.
12. Participates in developing written protocols, job aids, policies, workflow and standards for GEB and TouchWorks.
13. Works with SIUSOM GE and EHR system support departments to create, implement, and improve the billing and medical record systems, forms, and workflow.
Insurance Processing 35%
1. Determines when patients with insurance plans need waiver of benefit notices signed and explains peocess to patients.
2. Maintains up to date files on all managed care organizations, employers under each plan, and their network of providers and keep staff up to date on any changes in coverage.
3. Maintains list of managed care contacts and addresses for each organization and insurance company and ensure all staff have the most up to date information available.
4. Serves as liaison with managed care companies concerning status of referrals and authorizations to resolve referral issues and adjudicate claims disputes.
5. Corresponds with patients to answer all inquiries and to assist them in adjudicating claims where disputes over referrals and authorizations are involved.
6. Advises faculty and resident physicians, nurses and other staff regarding the appropriateness and medical necessity guidelines of managed care referrals and authorization requests.
7. Maintains log of activity reports documenting volume for Supervisor.
8. Maintains log of health care agency contract addresses and telephone numbers by specialty area.
9. Inv…
Title: Medical insurance assistant manager
Company: SIU Medicine
Location: Springfield, IL
Category:
