Medical Insurance Specialist

Details

Posted: 12-Apr-24

Location: Chicago, Illinois

Type: Full-time

Salary: Open

Categories:

Human Resources
Staff/Administrative

Internal Number: 5172448

Medical Insurance Specialist
Medical Insurance Specialist
Hiring Department: Division of Specialized Care for Children (DSCC)
Location: Springfield, IL USA
Requisition ID: 1022878
Posting Close Date: 4-21-24
About the University of Illinois Chicago
UIC is among the nation's preeminent urban public research universities, a Carnegie RU/VH research institution, and the largest university in Chicago. UIC serves over 34,000 students, comprising one of the most diverse student bodies in the nation and is designated as a Minority Serving Institution (MSI), an Asian American and Native American Pacific Islander Serving Institution (AANAPSI) and a Hispanic Serving Institution (HSI). Through its 16 colleges, UIC produces nationally and internationally recognized multidisciplinary academic programs in concert with civic, corporate and community partners worldwide, including a full complement of health sciences colleges. By emphasizing cutting-edge and transformational research along with a commitment to the success of all students, UIC embodies the dynamic, vibrant and engaged urban university. Recent 'Best Colleges' rankings published by U.S. News & World Report, found UIC climbed up in its rankings among top public schools in the nation and among all national universities. UIC has nearly 260,000 alumni, and is one of the largest employers in the city of Chicago.
Description:
Position Summary
Review, analyze and enter medical claims, interpret third party payment information, coordinate benefit coverage information in order to determine DSCC financial liability.
Employees at this level are senior representatives under limited supervision who provide technical assistance and guidance to DSCC staff, providers and families on complex issues independent of manager oversight to facilitate medical claims processing.
Duties & Responsibilities

Analyze , process and adjust paper & electronic claims for accuracy. Reviews case specific information to enter the prior approval for claim adjudication.

Resolve complex collections, provider and customer complaints independent of manager oversight.

Train providers to use the Provider Portal application and provides instructions on procedures and policies for claims adjudication.

Determines the policy provision for complex nursing and medical claims. Communicates findings with DSCC staff and providers. Determines a resolution to process the claim.

Reviews and analyzes provider claims and insurance explanation of benefits for quality assurance. Initiates, receives and documents telephone calls to facilitate claims payment process. Serves as the primary point of contact for providers, DSCC staff and families in various situations.

Determines appropriate adjustments needed when explanation of benefit's, refund checks or claims are resubmitted by providers or families.

Attends Division and university related meetings and serves as a departmental liaison in the absence of the manager.

Trains new and lower level staff on unit policies and procedures, including processing of claims. Reports and training issues to claims manager.

Identifies needs/problems with computer software programs and agency claims processing practices, makes recommendations for change or enhancement to manager.

Conducts file audits to obtain reimbursement of DSCC expenditures due to benefit coverage changes, claims processed incorrectly by insurance carriers and discrepancies of insurance benefit coverage.

Prepares reports or written correspondence for the manager as requested.

Assists manager on revisions to the Home Care and Core Department Manual.

May supervise lower level staff as assigned in the absence of the department manager.

Conducts quarterly quality assurance audits on finalized claims based on departmental guidelines.

Other duties as assigned.

Qualifications:
Minimum Qualifications

Any one or combination totaling two (2) years (24 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)
• 90 semester hours equals two (2) years (24 months)

Work experience in a healthcare environment working independently with medical claims, denials, rejections, referrals, and prior authorizations.

The University of Illinois System is an equal opportunity employer, including but not limited to disability and/or veteran status, and complies with all applicable state and federal employment mandates. Please visit Required Employment Notices and Posters to view our non-discrimination statement and find additional information about required background checks, sexual harassment/misconduct disclosures, COVID-19 vaccination requirement, and employment eligibility review through E-Verify.
The university provides accommodations to applicants and employees. Request an Accommodation
Looking for more University of Illinois positions?
We invite you to search for positions at each of the University of Illinois locations, the University of Illinois System Office and the University of Illinois Foundation. The University of Illinois System Office supports the primary missions of teaching, research, public service, and economic development for all of the Universities and offers positions in all locations. The University of Illinois Foundation is the official fundraising and private gift-receiving agency for the University of Illinois and also offers position in all locations. Click the links below to search for other University of Illinois positions.
University of Illinois Urbana-Champaign
University of Illinois Springfield
University of Illinois System Office
University of Illinois Foundation
The University of Illinois System is an equal opportunity employer, including but not limited to disability and/or veteran status, and complies with all applicable state and federal employment mandates. Please visit Required Employment Notices and Posters to view our non-discrimination statement and find additional information about required background checks, sexual harassment/misconduct disclosures, and employment eligibility review through E-Verify.
To apply, visit https://uic.csod.com/ux/ats/careersite/1/home/requisition/8116?c=uic
Copyright 2024 Jobelephant.com Inc. All rights reserved.
Posted by the FREE value-added recruitment advertising agency
jeid-96ce3d33a1af9a4eb66eb512e366a52f

Create a Job Alert for Similar Jobs
About University of Illinois - Chicago
The University of Illinois Chicago is the city’s largest university and its only public Carnegie Research 1 institution. Its 16 academic colleges serve close to 34,000 undergraduate, graduate and professional students. UIC is recognized as one of the best public universities and one of the most ethnically rich and culturally diverse campuses in the nation, located in the heart of Chicago, it is an integral part of the city's educational, technological and cultural fabric.
Connections working at University of Illinois - Chicago
More Jobs from This Employer
https://main.hercjobs.org/jobs/19982874/medical-insurance-specialist
Return to Search Results