What are the responsibilities and job description for the Medical Insurance Associate - UI Health, Revenue Cycle position at uic?
Under general supervision, the Medical Insurance Associate independently submits or takes the necessary actions to complete or process routine insurance claim/medical claim forms, referrals, and prior authorizations. They are also responsible for completing or processing moderately complex claim/medical forms, coordinating benefits between two or more third-party payers, and collecting outstanding payments. Employees at this level may train lower-level staff members.
Duties & 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.