Medical Insurance Manager

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Under the general direction of the SIU Medicine Deputy Director of Insurance Follow‑up, the incumbent in this position is responsible for the supervision of the insurance follow up team in Patient Business Services (PBS). The incumbent is responsible for overseeing the daily operations and inventory of the Insurance Follow‑Up team. This includes managing a variety of tasks for the Insurance Follow‑Up teams, analyzing denials, looking for trends and payor issues, following up on outstanding claims with insurance payors, overseeing training, updating workflows, reviewing explanation for correct payment, providing support to the staff, assistant manager, the Deputy Director in PBSs and Executive Director of Revenue Cycle.

The following information is intended to be representative of the work performed by Incumbent in this position and is not all‑inclusive. The omission of specific duty or responsibility will not preclude it from the position if the work is similar, related, or a logical extension of position responsibilities.

80% Supervision/Administration

• Provides day‑to‑day supervision of the Medical Asst‑Managers and corresponding staff within their teams.
• Responsible for interviewing, hiring, overseeing training within the Follow‑Up Teams.
• Approving leave time of the Asst‑Managers.
• Maintain responsibility for evaluating the work performance of the Follow‑up teams and enforcing disciplinary action as required.
• Plans, organizes, directs and controls the activities of subordinate staff in support of the duties and responsibilities outlined by the Deputy Director or Director.
• Responsible for the implementation of appropriate operating procedures and controls to assure maximum reimbursement from Managed Care, Commercial, Workers Comp, Medicaid, and Medicare intermediaries.
• Troubleshoots problems, provides assistance and directs faculty and staff to the appropriate resource to solve issues related to insurance denials and/or payor issues on charges/invoices.
• Work with Clinical staff either directly or through the Deputy Directors in identifying, developing, and implementing automated systems and processes which enhance the overall effectiveness of the unit and assure optimization of revenues and/or efficient and timely claims submission.
• Responsible for participating in and/or conducting presentations and/or educational workshops to both faculty and staff.

15% Reimbursement Analysis/Invoice Follow‑Up/Receipt Posting

• Review Managed Care, Commercial, Worker's Comp, Medicare, and Medicaid explanation of benefits (EOBs) to ensure that maximum reimbursement has been received. Follow‑up actions include requesting coding reviews, requesting appeals to review boards, requesting administrative hearing, etc.
• Review and audit in detail receipt listing for accurate posting to patient accounts. This includes posting receipts, discretionary and statutory write‑offs as directed.
• Provide post‑audit and quality assurance functions specific to Managed Care, Commercial, Worker's Comp, Medicaid, and Medicare reimbursement.
• Identify Adhoc reports for special projects and to isolate patterns to be reviewed by Managed Care, Commercial, Worker's Comp, Medicare, and Medicaid specialists, coding staff, administrative staff within SIU Medicine.
• Submit denial information to the medical coding staff in the clinical departments for review and coding decisions. Track requests for coding review. Resubmit claims based on the coding reviewer response or take write‑offs as directed.
• Request appropriate adjustment/write‑off for denied charges that do not need medical coding review (non‑covered service, untimely filings, etc.)
• Make appropriate entry of actions taken in the billing system modules.
• Respond to complex correspondence addressed to the Managed Care, Commercial, Worker's Comp, Medicare, and Medicaid staff.

5% Other duties as assigned.

Credentials to be verified by placement officer.