Medical Insurance Associate - Jacksonville (4582.2)

95% Internal & External Referral Coordination

1. Serve as patient advocate in securing referrals to specialist physicians and health care agencies.
2. Serve as liaison between managed care organizations and the physician's office, providing appropriate documentation for referrals, authorizations for hospital, testing or other services.
3. Responsible for determining and disseminating the required information from the patient's medical records, i.e., chart notes, school physicals, laboratory results, x-rays, etc., to assure the medical necessity of the request to the consultant, and/or insurance/managed care company.
4. Develop or secure patient education materials that explain each type of test, what the expectations are of the patient, along with information regarding the medical facility.
5. Responsible for providing feedback to nursing staff for follow-up on patients referred for laboratory or radiology.
6. Maintain up to date files on all managed care organizations, employers under each plan, and their network of providers.
7. Maintain up to date directory of services provided to FQHC patients by specialists and health care agencies.
8. Maintain list of managed care contacts for each organization and insurance company.
9. Advise faculty and resident physicians, nurses and other staff at the FQHC regarding the appropriateness and medical necessity guidelines of managed care referrals and authorization requests.
10. Maintain log of activity reports documenting volume for Supervisor.
11. Maintain log of health care agency contract addresses and telephone numbers by specialty area.

5% Other

12. Attend office managers meetings to keep abreast of managed care updates and insure compliance with managed care directives.
13. Participate in the development of appropriate forms for internal and external use as it relates to referrals.
14. Participate in staff meetings representing the Referral Unit.
15. Other duties as assigned.

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.

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.