Medical Insurance Representative (U)

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.

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

1. High school diploma or equivalent.
2. Any one or combination totaling six (6) 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 six (6) months
   2. Work experience in a healthcare environment working with medical claims, denials, rejections, referrals, and/ or prior authorization.

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.