Extra Help - Medical Insurance Representative - Surgery
About The Position
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 over 300,000 alumni, and is one of the largest employers in the city of Chicago. Under direct supervision of the Director of Administrative Operations, the Extra Help Medical Insurance Representative is responsible for investigating, analyzing, resolving, and preventing claim denials to ensure the Department receives appropriate reimbursement for services rendered. This role involves collaborating with insurance companies and internal teams to ensure proper claim resolution.
Requirements
- High school diploma or equivalent.
- Any one or combination totaling six (6) 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 six (6) months
- Work experience in a healthcare environment working with medical claims, denials, rejections, referrals, and/ or prior authorization.
Responsibilities
- Investigates, analyzes, resolves, and prevents claim denials to ensure the Department receives appropriate reimbursement for services rendered.
- Collaborates with insurance companies and internal teams to ensure proper claim resolution.
- Identifies root causes in denials, including high dollar surgical denials, and assist in implementing strategies to prevent future denials.
- Understand and apply basic medical terminology, coding, and billing and maintain an up-to-date understanding of billing and industry regulations.
- Reviews and analyzes routine payment, capitation, adjustment, or denial records and posts or adjusts records as required under the direct supervision of a supervisor.
- Submit appeals and coordinate letters of medical necessity and/or peer to peers.
- Perform other related duties and participate in special projects as assigned.
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What This Job Offers
Career Level
Entry Level
Industry
Hospitals
Education Level
High school or GED
Number of Employees
5,001-10,000 employees
