Southern Illinois University School of Medicine
Medical Insurance Representative (U)
Southern Illinois University School of Medicine, Springfield, Illinois, us, 62777
Salary:
$17.00 - $18.70 Hourly Location :
Springfield, IL Job Type:
Civil Service Remote Employment:
Flexible/Hybrid Job Number:
2400997 Department:
SIU HealthCare Patient Business Services-SMS Opening Date:
05/16/2025 Closing Date:
9/29/2025 2:00 PM Central FLSA:
Non-Exempt Bargaining Unit:
AFSCME Local 370 Shift:
Days ExemptorNon_Exempt:
Non-Exempt
Description
The function of this position examines and analyzes explanation of benefits to determine if correct payment has been made or to determine how to receive maximum benefits from the third party payor. The incumbent routinely reviews outstanding invoices to determine action steps needed to resolve the balance. This is an entry level position which functions in a training capacity under direct supervision processing routine, noncomplex medical/health claims.
Examples of Duties
75% Invoice Follow-up: Reviews Explanation Of Benefits (EOB) for denials Access patient account in the GE billing system. Determine action needed and proceed appropriately. Bill secondary insurance when appropriate. Transfer denied charge to patient or another responsible party as needed. Order medical notes when needed. Submit denial information to the medical coding staff in the clinical departments for review and coding decisions. Track requests for coding review. Resubmit claims based on the coding reviewer response or take write-offs as directed. Review charges that are paid to determine if further review is necessary. Request appropriate adjustment/write off for denied charges that do not need medical coding review (non-covered service, untimely filings, etc.) Retrieves EOB's from CD rom, microfilm or other hard copy records and files as needed. Make appropriate entry of actions taken in the billing system modules.
10% Insurance Follow-up: Contact Insurance company representatives to discuss denials and zero pays. If easily resolved, take appropriate action steps including resubmission, adjustments, request for review, etc. Forward to immediate supervisor or manager if necessary. Request telephone reviews of claims if appropriate. Make appropriate entry of actions taken in the billing system modules.
12% Correspondence: Opens and reviews incoming mail related to the payer teams. Responds to routine correspondence as needed.
3% Other duties as assigned
Qualifications
High school diploma or equivalent. Any one or combination totaling six (6) 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 six (6) months
Work experience in a healthcare environment working with medical claims, denials, rejections, referrals, and/ or prior authorization.
Supplemental Information If you require assistance, please contact the Office of Human Resources at 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 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. Paid time off: Includes 12 paid holidays per year. Accrual rates vary based on employment type and years of service
Paid sick time: Use for personal illness, doctor visits, or if your immediate family members fall ill
Health, Dental, and Life insurance
Optional life insurance: Your spouse and dependents can enroll in State term life and university-sponsored term life insurance.
Prescription: Plan participants enrolled in any state health plan have prescription drug benefits included in the coverage.
Long-term Disability Insurance
Flexible spending accounts: Optional, IRS tax-favored program that enables you to stretch medical expenses and dependent care dollars
Voluntary retirement accounts: Optional plans include the State of Illinois Deferred Compensation Plan (457) and Tax Deferred Annuity (403b).
Tuition Waiver/Tuition Reimbursement: Continue your graduate or undergraduate education with the help of tuition waivers or tuition reimbursement
Leaves of absence: Includes FMLA and Extended Sick Leave Benefits for qualified employees
Employee Assistance Program: Access free and confidential support, including counseling services, and information during difficult times
For more information please visit
$17.00 - $18.70 Hourly Location :
Springfield, IL Job Type:
Civil Service Remote Employment:
Flexible/Hybrid Job Number:
2400997 Department:
SIU HealthCare Patient Business Services-SMS Opening Date:
05/16/2025 Closing Date:
9/29/2025 2:00 PM Central FLSA:
Non-Exempt Bargaining Unit:
AFSCME Local 370 Shift:
Days ExemptorNon_Exempt:
Non-Exempt
Description
The function of this position examines and analyzes explanation of benefits to determine if correct payment has been made or to determine how to receive maximum benefits from the third party payor. The incumbent routinely reviews outstanding invoices to determine action steps needed to resolve the balance. This is an entry level position which functions in a training capacity under direct supervision processing routine, noncomplex medical/health claims.
Examples of Duties
75% Invoice Follow-up: Reviews Explanation Of Benefits (EOB) for denials Access patient account in the GE billing system. Determine action needed and proceed appropriately. Bill secondary insurance when appropriate. Transfer denied charge to patient or another responsible party as needed. Order medical notes when needed. Submit denial information to the medical coding staff in the clinical departments for review and coding decisions. Track requests for coding review. Resubmit claims based on the coding reviewer response or take write-offs as directed. Review charges that are paid to determine if further review is necessary. Request appropriate adjustment/write off for denied charges that do not need medical coding review (non-covered service, untimely filings, etc.) Retrieves EOB's from CD rom, microfilm or other hard copy records and files as needed. Make appropriate entry of actions taken in the billing system modules.
10% Insurance Follow-up: Contact Insurance company representatives to discuss denials and zero pays. If easily resolved, take appropriate action steps including resubmission, adjustments, request for review, etc. Forward to immediate supervisor or manager if necessary. Request telephone reviews of claims if appropriate. Make appropriate entry of actions taken in the billing system modules.
12% Correspondence: Opens and reviews incoming mail related to the payer teams. Responds to routine correspondence as needed.
3% Other duties as assigned
Qualifications
High school diploma or equivalent. Any one or combination totaling six (6) 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 six (6) months
Work experience in a healthcare environment working with medical claims, denials, rejections, referrals, and/ or prior authorization.
Supplemental Information If you require assistance, please contact the Office of Human Resources at 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 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. Paid time off: Includes 12 paid holidays per year. Accrual rates vary based on employment type and years of service
Paid sick time: Use for personal illness, doctor visits, or if your immediate family members fall ill
Health, Dental, and Life insurance
Optional life insurance: Your spouse and dependents can enroll in State term life and university-sponsored term life insurance.
Prescription: Plan participants enrolled in any state health plan have prescription drug benefits included in the coverage.
Long-term Disability Insurance
Flexible spending accounts: Optional, IRS tax-favored program that enables you to stretch medical expenses and dependent care dollars
Voluntary retirement accounts: Optional plans include the State of Illinois Deferred Compensation Plan (457) and Tax Deferred Annuity (403b).
Tuition Waiver/Tuition Reimbursement: Continue your graduate or undergraduate education with the help of tuition waivers or tuition reimbursement
Leaves of absence: Includes FMLA and Extended Sick Leave Benefits for qualified employees
Employee Assistance Program: Access free and confidential support, including counseling services, and information during difficult times
For more information please visit