Medical Insurance Specialist

This individual provides Medical Insurance Specialist Support to the Department of Obstetrics and Gynecology.

A. Maintains Referral Queue, Referral/Precert task list, Worklist, and Financial Authorization task list within our Electronic Medical Record and Centricity Business system.
B. Contacts insurance companies to pre-certify inpatient and outpatient surgical procedures, Implanon and IUD insertions and maternity care.
C. Contacts patient insurance providers to verify benefits prior to the scheduled procedure and/or appointments.
D. Acts as a liaison between physician practice and third-party providers/facilities.
E. Corresponds with insurance companies and Medicare, as required to identify and collect the correct information for entry into the patient database for billing purposes.
F. Receives and responds to calls from patients regarding status of insurance claims, pre-certifications, authorizations, etc.
G. Responds 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. Performs the duties of the financial counselor with regard to patient accounts in the case of scheduled time off or illness, or as requested.
I. Completes departmental FMLA and disability forms.
J. Works any reports deemed necessary for the area. (Ex. Ultrasound report, HMO Report, Molina report).
K. Acts a liaison with pharmacies patient's assistance programs for patients needing Lupron, Prolia etc. Includes faxing office notes and pertinent information requested to obtain coverage/approval.
L. Acts as a lead for Obstetrics and Gynecology departmental insurance staff, answering questions related to the authorization and referral process and providing direction in completion of their workload.
M. Assists in on-going training of the new and lower level medical insurance staff.

1. Any one or combination totaling two (2) years (24 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)
      • 90 semester hours equals two (2) years (24 months)
   2. Work experience in a healthcare environment working independently with medical claims, denials, rejections, referrals, and prior authorizations.

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.