SIU Medicine
Description
This person will serve as a Medical Insurance Associate on the denials team within the Department of Surgery. They will be responsible for all aspects of denials, appeals, and missing preauthorizations/pre-certifications of patient procedures for the Department of Surgery. The role involves interaction with physicians, nurses, supportive staff within the Department of Surgery, insurance companies, and outside facilities. Examples of Duties
Claim Denials and Appeals 85% Ensure all planned services were appropriately preauthorized to secure accurate billing for patient procedures (e.g., inpatient and outpatient surgery, rehab, drug, and DME). Review medical records for documentation and communicate with managed care/insurance companies to secure approved appeals. Resubmit denied claims with appeals or corrected billing information. Provide updates to faculty and staff regarding changes to managed care/insurance procedures and protocols. Respond to insurance-related inquiries, missing or incorrect prior authorizations, denials, and appeals. Identify, analyze, and take necessary actions on insurance denials to complete the medical review process, working closely with Coding and PBS teams. Gather additional health information from patients and/or physicians regarding denied episodes of care and initiate follow-up discussions and appeals with insurance organizations. Correspond with physicians, nurses, hospitals, government agencies, insurance companies, managed care companies, and patients to gather necessary information for authorization processes. Obtain standard codes from ICD-9 and CPT books after chart review/discussion with physicians or nurses and share with certifying agencies. II. Administrative 15% Attend training sessions, meetings, and review publications to stay current on insurance policies and procedures. Participate in SIU Healthcare committees as requested. Collect denial data and report findings to the Medical Insurance Assistant Manager/Administrator. Participate in SIU Physician & Surgeon meetings as requested. Perform other duties and projects as assigned. Qualifications
High school diploma or equivalent. Six months of experience in one or more of the following areas: college coursework in a health-related or management field (30 semester hours = 6 months), or work experience in a healthcare environment dealing with medical claims, denials, rejections, referrals, or prior authorizations. Supplemental Information
For assistance, contact the Office of Human Resources at hrrecruitment@siumed.edu or call 217-545-0223, Monday through Friday, 8:00 am - 4:30 pm. The mission of Southern Illinois University School of Medicine is to optimize the health of central and southern Illinois through education, patient care, research, and community service. The SIU School of Medicine Annual Security Report is available online at https://www.siumed.edu/police-security. This report complies with the Jeanne Clery Disclosure of Campus Security Policy and Crime Statistics Act. SIU School of Medicine is an Affirmative Action/Equal Opportunity employer, providing equal employment and educational opportunities without regard to race, color, religion, sex, national origin, age, disability, sexual orientation, veteran status, or marital status, in accordance with applicable laws. Pre-employment background screenings are required. #J-18808-Ljbffr
This person will serve as a Medical Insurance Associate on the denials team within the Department of Surgery. They will be responsible for all aspects of denials, appeals, and missing preauthorizations/pre-certifications of patient procedures for the Department of Surgery. The role involves interaction with physicians, nurses, supportive staff within the Department of Surgery, insurance companies, and outside facilities. Examples of Duties
Claim Denials and Appeals 85% Ensure all planned services were appropriately preauthorized to secure accurate billing for patient procedures (e.g., inpatient and outpatient surgery, rehab, drug, and DME). Review medical records for documentation and communicate with managed care/insurance companies to secure approved appeals. Resubmit denied claims with appeals or corrected billing information. Provide updates to faculty and staff regarding changes to managed care/insurance procedures and protocols. Respond to insurance-related inquiries, missing or incorrect prior authorizations, denials, and appeals. Identify, analyze, and take necessary actions on insurance denials to complete the medical review process, working closely with Coding and PBS teams. Gather additional health information from patients and/or physicians regarding denied episodes of care and initiate follow-up discussions and appeals with insurance organizations. Correspond with physicians, nurses, hospitals, government agencies, insurance companies, managed care companies, and patients to gather necessary information for authorization processes. Obtain standard codes from ICD-9 and CPT books after chart review/discussion with physicians or nurses and share with certifying agencies. II. Administrative 15% Attend training sessions, meetings, and review publications to stay current on insurance policies and procedures. Participate in SIU Healthcare committees as requested. Collect denial data and report findings to the Medical Insurance Assistant Manager/Administrator. Participate in SIU Physician & Surgeon meetings as requested. Perform other duties and projects as assigned. Qualifications
High school diploma or equivalent. Six months of experience in one or more of the following areas: college coursework in a health-related or management field (30 semester hours = 6 months), or work experience in a healthcare environment dealing with medical claims, denials, rejections, referrals, or prior authorizations. Supplemental Information
For assistance, contact the Office of Human Resources at hrrecruitment@siumed.edu or call 217-545-0223, Monday through Friday, 8:00 am - 4:30 pm. The mission of Southern Illinois University School of Medicine is to optimize the health of central and southern Illinois through education, patient care, research, and community service. The SIU School of Medicine Annual Security Report is available online at https://www.siumed.edu/police-security. This report complies with the Jeanne Clery Disclosure of Campus Security Policy and Crime Statistics Act. SIU School of Medicine is an Affirmative Action/Equal Opportunity employer, providing equal employment and educational opportunities without regard to race, color, religion, sex, national origin, age, disability, sexual orientation, veteran status, or marital status, in accordance with applicable laws. Pre-employment background screenings are required. #J-18808-Ljbffr