New

Medical Insurance Associate (U) (4582)

SIU Medicine
$36,605.25 - $40,265.78 Annually
medical insurance, dental insurance, life insurance, paid time off, paid holidays, sick time, extended sick time, tuition reimbursement, 403(b), retirement plan
United States, Illinois, Springfield
Sep 27, 2025
Description This person will be responsible for the preauthorization/precertification of patient procedures for the Department of Obstetrics and Gynecology and the Division of Endocrinology and Infertility. This person will interact with physicians, residents, nurses and secretarial staff. This person will also work with the other billing staff in the Department of OB/GYN and Reproductive Endocrinology and Infertility to pre-certify all procedures and surgeries and process referrals appropriately. Examples of Duties The following information is intended to be representative of the work performed by incumbent in this position and is not all-inclusive. The omission of a specific duty or responsibility will not preclude it from the position if the work is similar, related or a logical extension of position responsibilities. Demonstrates, by actions, commitment to the mission and the behavioral standards of SIU School of Medicine. Provides excellent service to both internal and external customers through collaboration and partnership; compassion and respect; integrity and accountability; diversity and inclusion; as well as continuous learning and improvement. MANAGEDCARE DUTIES 85% A. Maintains referral queue, Worklist, Referral/precertification, and financial authorization task boxes ensuring timely completion, tracking and documentation of necessary referral/pre-certifications for the Department of Obstetrics and Gynecology and SIU Fertility and IVF Center. B. Work good faith estimate report and daily schedule. C. Performs pre-certification of surgeries/procedures to ensure that proper authorizations or approvals are received prior to service. D. Provides proper consent documents to hospitals to ensure that all necessary paperwork is in place prior to date of service. E. Correspond with insurance companies, Medicaid and Medicare, as required to identify and collect the correct information for entry into the patient database for billing purposes. F. Receive and respond to calls from patients regarding the status of insurance claims, pre-certifications, authorizations, billing questions, etc. Also respond to physicians, hospitals, insurance companies, government agencies and related interested parties as it pertains to the resolution of claim reimbursements G. Respond to inquiries from physicians, nurses, hospitals, government agencies, insurance companies, managed care companies and patients concerning requests for assistance to assure appropriate coverage for planned medical services. H. Process patient requests for completion of FMLA and disability forms for the Division of Reproductive Endocrinology. I. Compiles insurance benefits and creates/maintains updated insurance verification sheets for the SIU Fertility and IVF Center. Flag appointments that need correct or updated insurance verification. J. Discuss insurance benefits or lack there of with ALL new patients within SIU Fertility and IVF Center. Explain cash payment option and prices to All patients who do not have coverage. K. Ensure referrals are in place for patient appointments with insurance companies when necessary. L. Interacts with physicians, residents, nurses, and insurance carriers to resolve problems concerning billing issues. M. Keep abreast of financial programs throughout County/State/Federal to better serve patient's needs ie:, IBCCP N. Assist in any Donor/Surrogate and Outside Monitoring questions. ADMINISTRATIVE 15% A. Attend training sessions, meetings and conferences and read publication store main current on the policies and procedures of managed care/insurance companies. B. Maintain list of managed care contacts for each organization and insurance company. C. Participate in the development of appropriate forms for internal and external use as ,t relates to referrals and pre-certs. D. Attend staff meetings as necessary. E. Other duties/projects as assigned. SKILLS AND ABILITIES NEEDED FOR THE POSITION: Ability to type accurately. Ability to follow verbal instructions and complex written directions. Ability to complete and process forms, selecting data from various sources. AbilitytounderstandandlearntheclinicalcomputingsystemusedbySIUMedicine. Knowledge of the precertification/preauthorization process. Excellent communication skills in dealing with patients, Department staff, managed care/insurance personnel and physicians. Maintain professional demeanor in interactions with all individuals, internal and external to the organization. Ability to handle stressful situations. Excellent organizational skills and abilities to multi-task and prioritize assignments. Basic Familiarity with and understanding of ICD-10 material and CPT guidelines. Experience with Managed Care insurance plans, understanding the mechanisms and processes of referral, authorization, approval, and pre-certification, including knowledge of Managed Care requirements, as well as, other payer reimbursement demands. Familiarity with Medicare, Medicaid, Managed Care and Commercial Insurance payers, complying with the various requirements to enhance reimbursements. Sensitive to the needs of under represented minority populations. Qualifications Any one or combination totaling one (1) year (12 months) from the categories below: 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) Work experience in a healthcare environment working with medical claims, denials, rejections, referrals, and prior authorizations. Condition of Employment: Pursuant to the State Universities Civil Service System, an out-of-state resident who is hired into this position must establish Illinois residency within 180 calendar days of their start date. Supplemental Information 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.* The SIU School of Medicine Annual Security Report is available online at https://www.siumed.edu/police-security. This report contains policy statements and crime statistics for Southern Illinois University School of Medicine in Springfield, IL. This report is published in compliance with Federal Law titled the "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.