University of Illinois Chicago
Springfield, IL - Medical Insurance Specialist (Core)
University of Illinois Chicago, Chicago, Illinois, United States, 60290
Position Summary
Review, analyze and enter medical claims, interpret third party payment information, coordinate benefit coverage information in order to determine DSCC financial liability. Duties & Responsibilities
Analyze, process and adjust paper & electronic claims for accuracy. Reviews case specific information to enter the prior approval for claim adjudication. Resolve complex collections, provider and customer complaints independent of manager oversight. Train providers to use the Provider Portal application and provides instructions on procedures and policies for claims adjudication. Determines the policy provision for complex nursing and medical claims. Communicates findings with DSCC staff and providers. Determines a resolution to process the claim. Reviews and analyzes provider claims and insurance explanation of benefits for quality assurance. Initiates, receives and documents telephone calls to facilitate claims payment process. Serves as the primary point of contact for providers, DSCC staff and families in various situations. Determines appropriate adjustments needed when explanation of benefit's, refund checks or claims are resubmitted by providers or families. Attends Division and university related meetings and serves as a departmental liaison in the absence of the manager. Trains new and lower level staff on unit policies and procedures, including processing of claims. Reports and training issues to claims manager. Identifies needs/problems with computer software programs and agency claims processing practices, makes recommendations for change or enhancement to manager. Conducts file audits to obtain reimbursement of DSCC expenditures due to benefit coverage changes, claims processed incorrectly by insurance carriers and discrepancies of insurance benefit coverage. Prepares reports or written correspondence for the manager as requested. Assists manager on revisions to the Home Care and Core Department Manual. May supervise lower level staff as assigned in the absence of the department manager. Conducts quarterly quality assurance audits on finalized claims based on departmental guidelines. Other duties as assigned. Minimum Qualifications
Any one or combination totaling two (2) years (24 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) 90 semester hours equals two (2) years (24 months)
Work experience in a healthcare environment working independently with medical claims, denials, rejections, referrals, and prior authorizations.
Preferred Qualifications
Preferred qualifications are noted in the job posting but not listed in the raw description. To Apply
For fullest consideration click on the Apply Now button, please fully complete all sections of the online application including adding your full work history with specific details of your duties & responsibilities for each position held. Fully complete the education, licensure, certification and language sections. You may upload a resume, cover letter, certifications, licensures, transcripts and diplomas within the application. Please note that once you have submitted your application you will not be able to make any changes. In order to revise your application you must withdraw and reapply. You will not be able to reapply after the posting close date. Please ensure the application is fully completed and all supporting documents have been uploaded before the posting close date. Illinois Residency is required within 180 days of employment. To apply, visit
https://uic.csod.com/ux/ats/careersite/1/home/requisition/18471?c=uic The University of Illinois System is an equal opportunity employer, including but not limited to disability and/or veteran status, and complies with all applicable state and federal employment mandates. Please visit Required Employment Notices and Posters to view our non-discrimination statement and find additional information about required background checks, sexual harassment/misconduct disclosures, and employment eligibility review through E-Verify. The university provides accommodations to applicants and employees. Request an Accommodation
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Review, analyze and enter medical claims, interpret third party payment information, coordinate benefit coverage information in order to determine DSCC financial liability. Duties & Responsibilities
Analyze, process and adjust paper & electronic claims for accuracy. Reviews case specific information to enter the prior approval for claim adjudication. Resolve complex collections, provider and customer complaints independent of manager oversight. Train providers to use the Provider Portal application and provides instructions on procedures and policies for claims adjudication. Determines the policy provision for complex nursing and medical claims. Communicates findings with DSCC staff and providers. Determines a resolution to process the claim. Reviews and analyzes provider claims and insurance explanation of benefits for quality assurance. Initiates, receives and documents telephone calls to facilitate claims payment process. Serves as the primary point of contact for providers, DSCC staff and families in various situations. Determines appropriate adjustments needed when explanation of benefit's, refund checks or claims are resubmitted by providers or families. Attends Division and university related meetings and serves as a departmental liaison in the absence of the manager. Trains new and lower level staff on unit policies and procedures, including processing of claims. Reports and training issues to claims manager. Identifies needs/problems with computer software programs and agency claims processing practices, makes recommendations for change or enhancement to manager. Conducts file audits to obtain reimbursement of DSCC expenditures due to benefit coverage changes, claims processed incorrectly by insurance carriers and discrepancies of insurance benefit coverage. Prepares reports or written correspondence for the manager as requested. Assists manager on revisions to the Home Care and Core Department Manual. May supervise lower level staff as assigned in the absence of the department manager. Conducts quarterly quality assurance audits on finalized claims based on departmental guidelines. Other duties as assigned. Minimum Qualifications
Any one or combination totaling two (2) years (24 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) 90 semester hours equals two (2) years (24 months)
Work experience in a healthcare environment working independently with medical claims, denials, rejections, referrals, and prior authorizations.
Preferred Qualifications
Preferred qualifications are noted in the job posting but not listed in the raw description. To Apply
For fullest consideration click on the Apply Now button, please fully complete all sections of the online application including adding your full work history with specific details of your duties & responsibilities for each position held. Fully complete the education, licensure, certification and language sections. You may upload a resume, cover letter, certifications, licensures, transcripts and diplomas within the application. Please note that once you have submitted your application you will not be able to make any changes. In order to revise your application you must withdraw and reapply. You will not be able to reapply after the posting close date. Please ensure the application is fully completed and all supporting documents have been uploaded before the posting close date. Illinois Residency is required within 180 days of employment. To apply, visit
https://uic.csod.com/ux/ats/careersite/1/home/requisition/18471?c=uic The University of Illinois System is an equal opportunity employer, including but not limited to disability and/or veteran status, and complies with all applicable state and federal employment mandates. Please visit Required Employment Notices and Posters to view our non-discrimination statement and find additional information about required background checks, sexual harassment/misconduct disclosures, and employment eligibility review through E-Verify. The university provides accommodations to applicants and employees. Request an Accommodation
#J-18808-Ljbffr