Medical Insurance Associate (U) (4582)

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. Process 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. Open, print and close batch proof; balance after daily use. 15% Contact Insurance company representatives to discuss denials and zero pays. Able to make complex decisions when resolving accounts, 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. 10% Opens and reviews incoming mail related to the payer team. Responds to complex correspondence as needed or as instructed by the Insurance Assistant Manager. 5% Other duties as assigned. Maintain personal Procedure Manual with current procedures for reference Credentials to be Verified by Placement Officer: Any one or combination totaling one (1) year (12 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) Work experience in a healthcare environment working with medical claims, denials, rejections, referrals, and prior authorizations. Knowledge, Skills and Abilities (KSA's): Knowledge of principles and processes for providing customer and personal services. This includes customer needs assessment, meeting quality standards for services, and evaluating customer satisfaction. Knowledge of the structure and content of the English language including the meaning and spelling of words, rules of composition, and grammar. Knowledge of medical terminology and hospital or physician billing, coding, referrals, and prior authorizations. Knowledge of basic arithmetic with the ability to add, subtract, multiply and divide whole numbers, decimals and percentages. Skill in using computers and computer systems (including hardware and software) to program, write, set up functions, enter data, or process information. Ability to pay close attention to details and follow established procedures in completing work tasks. Ability to maintain patient confidentiality following HIPAA guidelines and established policies and procedures. Ability to convey moderately complex billing, claims, referral, and prior authorization information to patients and staff. Ability to train others to work collaboratively, building strategic relations with colleagues, coworkers, constituents. Condition of Employment: Pursuant to the State Universities Civil Service System, an out-of-state resident who is hired into this position must establish Illinois residency within 180 calendar days of their start date.