Medical Insurance Associate (U) (4582)

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. The incumbent processes various types of moderately complex insurance claim forms and is also responsible for taking the necessary action to complete claim forms, and coordinate benefits between third party payers.

1. takes the necessary action to complete, bill, collect or adjudicate moderately complex medical claims;
2. schedules internal referral appointments in the billing system per protocol;
3. posts and adjusts the benefits or financial files for persons utilizing the program;
4. interprets standard, established codes provided by the various agencies or healthcare providers and adjudicates procedures according to these interpretations;
5. reviews and analyzes itemized bills or claim forms for consistency and investigates discrepancies to determine the appropriate course of action required to complete the adjudication or billing process accurately;
6. trains Medical Insurance Representative and related support staff;
7. serves as a liaison between insurance and providers to ensure coverage and benefits before treatment, act as a patient advocate in securing and scheduling referrals, pre-authorizations, or pre-certifications;
8. assists in counseling patients, students, and parents about plan eligibility, benefits, and enrollment;
9. collects, reviews, and analyzes payment, capitation, adjustment, or denial records, and posts or adjusts records as required;
10. reviews billing data for accuracy and/or completeness and make the necessary corrections;
11. performs duties consistent with lower-level of series;
12. performs other related duties as assigned.

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.