Medical Insurance Specialist (Extra Help/Temporary) (5572)

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To help manage epic transition-
including tasks such as claim corrections, Medicaid DDE entries, TES edits, and appeals - additional support is necessary to maintain operational efficiency, meet performance standards, and reduce the risk of errors or backlogs.

*This position is ON SITE only*

Analyze patient accounts to ensure insurance billing is accurate and complete.
* Enter and verify patient demographic and insurance data in the practice management system (PMS).
* Collect and confirm patient insurance eligibility using online tools, payer websites, and direct communication with insurance companies, guarantors, or patients.
* Assist with patient refunds and handle patient account credits in accordance with policy.
* Review and process basic insurance denials, including pulling related medical records and performing manual charge entry as needed.
* Review Explanation of Benefits (EOBs) for accuracy and follow up on denied claims.
* Document actions taken in billing systems and update relevant modules accordingly.
* Review medical records and assign appropriate diagnosis and procedure codes using ICD-10-CM, CPT, and HCPCS coding systems.
* Ensure proper use and assignment of evaluation and management (E/M) modifiers and procedure-specific modifiers.
* Respond to inquiries from Patient Business Services (PBS) regarding claim corrections, including coding, service dates, place of service, and provider information.
* Draft and submit appeal letters to insurance payers for reconsideration of denied claims based on coding or documentation review.
* Self-Pay Credits (Credit Balance ETM)
* Self- pay credits go well, we could add insurance credits (Credit Balance ETM)
* Scanning Paper Documents in the office
* Correspondence denial posting
* Work no-activity claims views
* Work claims in Medicaid DDE (direct data entry) system
* Work eligibility denial views
* Eligibility ETM
* Ins follow up ETM
* Patient Correspondence
* CLS accounts (Bad Debt)
* Self-set up payment plans-needing set up in IDX
* Assist with gathering medical records
* Manually create visits for patients in order to post charges
* Work TES edits

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.

The SIU School of Medicine Annual Security Report is available online at https://www.siumed.edu/police-security. 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.