This person will be responsible for the preauthorization/precertification of patient procedures for the Department of Obstetrics and Gynecology and the Division of Endocrinology and Infertility. This person will interact with physicians, residents, nurses and secretarial staff. This person will also work with the other billing staff in the Department of OB/GYN and Reproductive Endocrinology and Infertility to pre-certify all procedures and surgeries and process referrals appropriately. 

*This position is On Site Only*MANAGED CARE DUTIES 85%
A Maintains referral queue, Worklist, Referral/precertification, and financial authorization task boxes ensuring timely completion, tracking and documentation of necessary referral/pre-certifications for the Department of Obstetrics and Gynecology and SIU Fertility and IVF Center.
B. Work good faith estimate report and daily schedule.
C. Performs pre-certification of surgeries/procedures to ensure that proper authorizations or approvals are received prior to service.
D. Provides proper consent documents to hospitals to ensure that all necessary paperwork is in place prior to date of service.
E. Correspond with insurance companies, Medicaid and Medicare, as required to identify and collect the correct information for entry into the patient database for billing purposes.
F Receive and respond to calls from patients regarding the status of insurance claims, pre-certifications, authorizations, billing questions, etc. Also respond to physicians, hospitals, insurance companies, government agencies and related interested parties as it pertains to the resolution of claim reimbursements
G. Respond to inquiries from physicians, nurses, hospitals, government agencies, insurance companies, managed care companies and patients concerning requests for assistance to assure appropriate coverage for planned medical services.
H. Process patient requests for completion of FMLA and disability forms for the Division of Reproductive Endocrinology.
I. Compiles insurance benefits and creates/maintains updated insurance verification sheets for the SIU Fertility and IVF Center. Flag appointments that need correct or updated insurance verification.
J. Discuss insurance benefits or lack thereof with ALL new patients within SIU Fertility and IVF Center. Explain cash payment option and prices to ALL patients who do not have coverage.
K. Ensure referrals are in place for patient appointments with insurance companies when necessary.
L. Interacts with physicians, residents, nurses, and insurance carriers to resolve problems concerning billing issues.
M. Keep abreast of financial programs throughout County/State/Federal to better serve patient's needs ie:, IBCCP
N. Assist in any Donor/Surrogate and Outside Monitoring questions.

ADMINISTRATIVE 15%
A  Attend training sessions, meetings and conferences and read publications to remain current on the policies and procedures of managed care/insurance companies
B Maintain list of managed care contacts for each organization and insurance company.
C. Participate in the development of appropriate forms for internal and external use as it relates to referrals and pre-certs.
D. Attend staff meetings as necessary.
E. Other duties/projects as assigned.

Credentials to be Verified by Placement Officer:

1. Any one or combination totaling one (1) year (12 months) from the categories below:
   1. 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)
   2. Work experience in a healthcare environment working with medical claims, denials, rejections, referrals, and prior authorizations.

Knowledge, Skills and Abilities (KSA's):

1. 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.
2. Knowledge of the structure and content of the English language including the meaning and spelling of words, rules of composition, and grammar.
3. Knowledge of medical terminology and hospital or physician billing, coding, referrals, and prior authorizations.
4. Knowledge of basic arithmetic with the ability to add, subtract, multiply and divide whole numbers, decimals and percentages.
5. Skill in using computers and computer systems (including hardware and software) to program, write, set up functions, enter data, or process information.
6. Ability to pay close attention to details and follow established procedures in completing work tasks.
7. Ability to maintain patient confidentiality following HIPAA guidelines and established policies and procedures.
8. Ability to convey moderately complex billing, claims, referral, and prior authorization information to patients and staff.
9. 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. 

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