Medical Insurance Associate (U) (4582)

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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.

*This position is ON SITE only*

Obtains and Verifies Demographic and Insurance Information 60%
1) Collects pertinent patient demographic information and enters data completely and accurately into practice
management system.
2) Collects pertinent patient insurance information and verifies insurance information and eligibility using electronic online
eligibility modules, payer websites or phone calls to payers. Enters data completely and accurately into practice
management system.
3) Ensures all applicable billing information and requirements are obtained and entered into practice management
system.
4) Assists patients in understanding insurance benefits including copays, deductibles and referrals.
5) Accesses billing system and insurance websites to assess rejections and contact patients or payers to resolve
discrepancies.
6) Accesses affiliated hospital data bases to obtain demographic and/or insurance information.
7) Able to make complex decisions when resolving eligibility related errors found on accounts.
Customer Service 35%
1) Receives and handles calls from patients, insurance companies, other outside parties and SIU employees.
2) Accurately assists patients in setting up monthly payment plans through SIU or Access One.
3) Make outbound calls to patients and payers.
4) Maintain strict confidentiality regarding knowledge of all patient information.
Other Duties 5%
Performs other duties as required or assigned which are reasonably within the scope of the duties described above.

Credentials to be Verified by Placement Officer:

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.

1. Knowledge of principles and processes for providing customer and personal services. This includes customer needs assessment, meeting quality standards for services, and evaluating customer satisfaction.
2. Knowledge of the structure and content of the English language including the meaning and spelling of words, rules of composition, and grammar.
3. Knowledge of medical terminology and hospital or physician billing, coding, referrals, and prior authorizations.
4. Knowledge of basic arithmetic with the ability to add, subtract, multiply and divide whole numbers, decimals and percentages.
5. Skill in using computers and computer systems (including hardware and software) to program, write, set up functions, enter data, or process information.
6. Ability to pay close attention to details and follow established procedures in completing work tasks.
7. Ability to maintain patient confidentiality following HIPAA guidelines and established policies and procedures.
8. Ability to convey moderately complex billing, claims, referral, and prior authorization information to patients and staff.
9. Ability to train others to work collaboratively, building strategic relations with colleagues, coworkers, constituents.

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.