Under the supervision of the, Medical Insurance Assistant Manager, the Medical Insurance Representative is responsible for ensuring all treatment is authorized by insurance for payment. The medical insurance representative takes appropriate action to ensure all medical and dental claims are reviewed and submitted with appropriate CPT/CDT and diagnosis codes. This position may also assist in various revenue cycle operations including, but not limited to: insurance verification, benefit coordination, claim submission and processing insurance denials.

Prior/Post Authorization

• Reviews and submits prior authorizations for all procedures by corresponding with third party medical and dental insurance payers to verify eligibility and coverage.
• Documents all appropriate communication and insurance correspondences in the electronic health record
• Performs detailed analysis reconciling all procedures completed in the OR with those submitted for prior authorization, noting any discrepancies and requesting a post authorization when applicable.
• Assist with ensuring financial readiness prior to surgery

Medical Billing

• Reviews clinical notes to determine appropriate CPT and diagnosis codes, noting any discrepancies and takes appropriate action to accurately complete the claim and process for payment.
• Submits claims to third party medical claims processor by scanning and uploading into portals for timely submission
• Maintains up-to-date understanding of billing and coding regulations
• Monitors and tracks all clinic and hospital billing for timely submission and completeness.

Communication

• Responds to a variety of questions from internal customers and external insurance agencies concerning the status of various billing aspects including but not limited to prior/post authorizations, claim status, billing submission.
• Works closely with Residents to obtain proper clinical documentation needed for prior authorizations. 

Payments/Denials

• Reviews and analyzes itemized estimate of benefits, applies payments, investigates issues including denials, coordinating with secondary insurance and updates information in a timely matter.

Perform other related duties and participate in special projects as assigned.

Minimum Qualifications:

1. Any one or any combination that equals six (6) months from the categories below:

a) Experience within a health insurance/medical billing environment

b) Medical billing certification from an accredited program (i.e., Certified Professional Coder (CPC); Registered Health Information Technician (RHIT); Certified Coding Specialist (CCS); Registered Health Information Administrator (RHIA); National Healthcareer Association (NHA))

c) College coursework in insurance/benefits administration, human resource management, health information management, finance, accounting or closely related fields such as business administration and/or business management

• 30 semester hours equals (6) months
• 60 semester hours equals (1) year (12 months)
• 90 semester hours equals (2) years (24 months)
• 120 semester hours or higher equals (3) years (36 months)

2. Demonstrated experience with medical-dental software systems (OneSource Passport and EPIC), medical diagnostic coding (ICD-10-CM), dental (CDT) and medical (CPT) procedure coding and applied terminology, and ability to gather data for financial reporting, create spreadsheets and provides statistical analysis.

Preferred Qualifications:

• Experience with CPT and ICD-10
• Familiar with third party payers including Medicaid and Delta Dental
• Knowledge of Microsoft office, Axium software, CDT
• ability to gather data for reporting
• Excellent Customer Service
• Process Improvement experience
• Excellent problem solving skills.

To Apply: For fullest consideration, please complete an online application by clicking the Apply for Position button below.

Please upload all valid certifications and transcripts within the document section of your online application. 

All civil service positions require an exam.  You will be required to report in person for this exam.

When completing your online application, please be sure to provide detailed information about your job knowledge and specific duties and responsibilities, as your qualifications for any Civil Service position will be primarily determined based on what is contained in the application. Dates of employment and if employed on a full or part time basis (including number of hours per week) must be indicated for each position held. Additional consideration will be given to supporting documentation i.e. resume, transcripts, licenses, and certifications so please be sure to attach all applicable documents.

If a degree or college coursework is required, you must provide official transcripts.

Transcripts/Licenses/Certifications MUST be uploaded electronically to your online application through the "Documents" page on the Civil Service Employment Application (page 4). Be sure to select the appropriate document type before uploading the document.

If your educational institution provides electronic transcripts, please have them sent to joannes@uic.edu.

If your educational institution doesn’t provide electronic transcripts, they must mail the transcripts to:

University of Illinois at Chicago
Recruitment and Staffing
Human Resources Building Room 109
715 S. Wood Street M/C 862
Chicago IL 60612
Attn: CC9787 - Medical Insurance Representative - JKN

If an application and all applicable forms, transcripts, and supporting documents are not submitted by the close date, the applicant/employee will not be considered for this position and will be denied. 

For fullest consideration, the above mentioned requirements must be submitted no later than Friday, April 9, 2021.

We appreciate your interest in employment at the University of Illinois at Chicago. 

The University of Illinois is an Affirmative Action/Equal Opportunity Employer.