Medical Insurance Specialist (4582) - Carbondale

The primary purpose of this position is to be respsonsible for billing and coding appeals/denials for all outpatient and inpatient services for SIU Center for Family Medicine - Carbondale. This position reviews denials for needed corrections indicated.

90% Inpatient and Outpatient Denials
1. Performs timely and accurate review of billing related denials, appeal and submission, including tracking findings for inpatient and outpatient billing.
2. Addresses denied claims and performs research to resolve coding related rejections.
3. Demonstrates a strong understanding of basic medical terminology, coding, and billing and stays current with federal, state and departmental guidelines and procedures related to billing and coding.
4. Reviews medical records and coded data to assess whether coding or billing adjustments are required or if an appeal should be initiated for resolution.
5. Examines denied claims for potential coding or billing errors, ensuring accuracy and completeness, makes the necessary corrections or provides supporting chart documentation for re-submission to facilitate claims payment consideration.
6. Reviews all denial accounts for categorization, level of appeal, and special requirements for initiating appeals.
7. Create and maintain an appeal process including letters for all outpatient, inpatient, and clinic denials.
8. Reviews and analyzes itemized bills or claim forms for consistency and investigates discrepancies to determine the appropriate course of action required to complete the adjudication or billing process accurately.
9. Monitors and tracks denial trends to help identify education/feedback opportunities.
10. Attends department meetings to discuss denial trends and prevention opportunities.
11. Works TES edits to make sure adjustments are made to posted batches as required by Claims Manager claims scrubber.
12. Corresponds with third party payers to resolve billing issues.
13. Acts as a liaison for physicians, patients, hospitals, insurance companies, government agencies, and related interested parties concerning the status of medical bills, problem claims, denials and appeals.
14. Support co-workers and engage in positive interactions.

10% Miscellaneous
1. Attend seminars and/or read publications to increase knowledge and understanding of CPT and ICD10 coding and billing processes as well as to remain up to date regarding reimbursement policies of payers such as Medicare, Medicaid and managed care payers.
2. Other duties as assigned

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.