New

Medical Insurance Associate (U) (4582)

SIU Medicine
$18.70 - $20.57 Hourly
medical insurance, dental insurance, life insurance, paid time off, paid holidays, sick time, extended sick time, tuition reimbursement, 403(b), retirement plan
United States, Illinois, Springfield
Mar 30, 2026
We recommend using the following browsers to complete the application: Desktop: Google Chrome, Edge with Chromium Mobile: Google Chrome, Safari Description The primary function is to verify patient demographic information, insurance eligibility and handle managed care referrals and pre-authorizations for the SIU Medicine. Under general supervision, the Medical Insurance Representative submits or takes the necessary actions to complete or process various types of routine and moderately complex insurance claim/ medical claim forms. They are also responsible for duties related to insurance verification, serving as an insurance liaison, securing referrals to specialty physicians, health care agencies, outpatient testing and other services. As well as, coordinating benefits between two or more third party payers, and collect outstanding payments. This position is ON SITE only. Examples of Duties Managed Care - 95% Initiates and completes all types of managed care referrals/pre-authorizations at the direction of the patient's physician in order to secure approval for the patient's ongoing medical care. Schedules outpatient and inpatient testing with off-site locations. Enters orders/referrals in the practice manage system and links to the appropriate appointment. Reviews patient medical records for necessary documentation and disseminates the appropriate information to the insurance companies in order to secure approval of the precertification. Responds to a variety of questions from clinical staff, physicians and patients concerning the proper action to be taken to properly retain authorizations/pre-certifications. Secures additional health information from the patient and/or physician office regarding the episode of care being denied; initiates follow-up discussions with the managed care organizations in order to obtain a review of referrals for medical care. Corresponds with and responds to a variety of questions of inquiries from healthcare providers, patients, or plan members, insurance companies, government agencies and person utilizing the services of the program/plans as required to identify and collect the information required to complete the necessary form or medical claims for the reimbursement to/from the various agencies. Report and resolve third party denials under indirect guidance from the supervisor. Acts as a liaison among patients, physicians, hospitals, insurance companies, and related parties regarding the sensitive disposition of problem claim reimbursements due to precertification issues. Miscellaneous - 5% Other duties as assigned. Qualifications 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. Supplemental Information 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.