Overview
Medical Insurance Specialist Jobs in Springfield, Illinois, USA at SIU Medicine
Description
The function of this position involves examining and analyzing explanations of benefits to determine if correct payments have been made or to identify how to maximize benefits from third-party payers. The incumbent routinely reviews outstanding invoices to determine necessary action steps to resolve balances. They also assist with training new staff and support lower-level Medical Insurance staff with questions.
Examples of
Duties
70% Invoice Follow-up:
Works independently and closely with the Team Manager. Completes complex tasks assigned by the Team Manager. Reviews explanations of benefits (EOB) for denials. Accesses patient accounts in the Centricity Business billing system to determine and execute appropriate actions. Responds to questions from lower-level Medical Insurance staff regarding insurance claim procedures. Assists in training and evaluating new staff. Reviews complex accounts, bills secondary insurance when applicable, transfers denied charges, orders medical notes, submits denial information to coding staff, tracks coding reviews, resubmits claims, updates patient insurance information, orders claim forms, retrieves EOBs, and manages billing system entries.
15% Insurance Follow-up:
Contacts insurance representatives regarding denials and zero payments. Makes complex decisions to resolve accounts, including resubmissions and adjustments. Requests claim reviews if necessary and records actions in the billing system.
10% Correspondence:
Manages incoming mail related to the payer team, responds to complex correspondence as instructed.
5% Other duties: Maintains personal procedure manual with current procedures.
Qualifications
Any combination totaling two (2) years (24 months) from the following categories:
College coursework in health-related fields, business administration/management, human resources, or related areas, with conversion to months as specified, or
Work experience in a healthcare environment handling medical claims, denials, rejections, referrals, and prior authorizations.
Supplemental Information
For assistance, contact the Office of Human Resources at hr recruitment or , Monday-Friday, 8:00am-4:30pm.
The mission of Southern Illinois University School of Medicine is to optimize health through education, patient care, research, and community service.
The SIU School of Medicine Annual Security Report is available online at https://(Use the “Apply for this Job” box below). complying with the Jeanne Clery Act.
SIU School of Medicine is an Affirmative Action/Equal Opportunity employer, providing equal opportunities regardless of race, color, religion, sex, national origin, age, disability, sexual orientation, veteran status, or marital status. Pre-employment background checks are required.
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Title: Medical Insurance Specialist
Company: SIU Medicine
Location: Springfield, Illinois, USA
Category: Healthcare (Healthcare Administration, Medical Billing and Coding), Administrative/Clerical (Healthcare Administration)
