Medical Insurance Associate - Quincy (4582)

This position at the Federally Qualified Health Center (FQHC) serves as a medical insurance associate to patients. This position serves as liaison with specialist offices and ancillary services (e.g., lab, radiology, CT, MRI, major procedures) by coordinating the care patients receive among the different providers.  In addition, this position serves as the primary contact for managed care and health maintenance organizations by obtaining the necessary approvals and documentation to proceed with providing services.  This position involves direct contact with patients. This position will also be responsible for assisting patients in obtaining medical coverage, on-site collection of bills, setting up payment plans and for qualifying and enrolling patients for Medicaid, Medicare or through the State of Illinois Insurance Exchange. 

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 a specific duty or responsibility will not preclude it from the position if the work is similar, related, or a logical extension of position responsibilities.

Demonstrates, by actions, commitment to the mission and the behavioral standards of SIU School of Medicine. Provides excellent service to both internal and external customers through collaboration and partnership; compassion and respect; integrity and accountability; diversity and inclusion; as well as continuous learning and improvement. 

55% SUPPORT FOR DIRECT PATIENT CARE

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. 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.
4. 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.
5. Responsible for providing feedback to nursing staff for follow-up on patients referred for laboratory or radiology.
6. Respond to a variety of questions from physicians, hospitals, government agencies, insurance companies and related interested parties concerning the status of insurance claims.
7. Document notes and adjustments to keep patient's account accurate and up to date and to inform others who may access the account

30%   INSURANCE PROCESSING/ELIGIBILITY ASSISTANCE

1. Enforce and implement FQHC federal rules and regulations regarding eligibility for patients with no insurance to qualify for Medicaid, Medicare or the purchase of insurance through the State Insurance Exchange. Obtain a CAC and SHIP certification and renew yearly.
2. Assist patients in completing applications by providing the appropriate information for them to apply for coverage through the appropriate plan or assist them to apply on-site through the patient kiosk.
3. Review patient applications and financial statements and following the process for "Means Testing", inform patient what plan or plans for which they qualify.
4. Keep detailed records to include patient's application for assistance and patient's financial statements.
5. Prepare monthly report for Administrator to include numbers of applications reviewed, numbers approved, and number of patients who qualify for plans by percentage of poverty level.

10%FINANCIAL COUNSELING/COLLECTIONS

2.  Meet with patients to collect on accounts, discuss payment options, and set up payment plans.

3.   To perform duties, master use of internal and external systems: SIU Scheduling/billing system and EHR for SIU and Blessing.

4.Keep abreast of online updates from HFS, CMS and forward important information to appropriate units affected, e.g., new approved drug lists, changes      in payments for certain services, etc.

5.   Perform eligibility checking using insurance websites as needed.

5% OTHER

1. Keep abreast of other coverage options for patients, i.e., Illinois Breast and Cervical Cancer Program , Parenthood, Local County Health Department, and others agencies.
2. Attend workshops and seminars conducted by the Illinois Primary Health Care Association and the State of Illinois to stay informed as needed.
3. Participate in the development of appropriate forms for internal and external use as it relates to referrals.
4. Other duties as assigned.

KNOWLEDGE, SKILLS, AND ABILITIES NEEDED FOR POSITION

Sensitive to the needs of underrepresented minority populations.