Medical Insurance Associate - UI Health, Revenue Cycle

About the role

The University of Illinois Hospital & Health Sciences System (UI Health) provides comprehensive care, education, and research to the people of Illinois and beyond. UI Health comprises a clinical enterprise that includes a Joint Commission-accredited tertiary care hospital and outpatient clinics, and the Mile Square Health Center network of federally qualified health centers. It also includes the seven UIC health science colleges.

Responsibilities

• Takes the necessary action to complete, bill, collect or adjudicate moderately complex medical claims;
• Schedules internal referral appointments in the billing system per protocol;
• Posts and adjusts the benefits or financial files for persons utilizing the program;
• Interprets standard, established codes provided by the various agencies or healthcare providers and adjudicates procedures according to these interpretations;
• 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;
• Trains Medical Insurance Representative and related support staff;
• Serves as a liaison between insurance and providers to ensure coverage and benefits before treatment, act as a patient advocate in securing and scheduling referrals, pre-authorizations, or pre-certifications;
• Assists in counseling patients, students, and parents about plan eligibility, benefits, and enrollment;
• Collects, reviews, and analyzes payment, capitation, adjustment, or denial records, and posts or adjusts records as required;
• Reviews billing data for accuracy and/or completeness and make the necessary corrections;
• Performs duties consistent with lower-level of series;
• Perform other related duties and participate in special projects as assigned.

Qualifications

• 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.