This position is located in the Health Sciences building on the IUPUI Campus.
Primary Role: Responsible for all aspects of insurance verification, billing, and claims resolution. Responsible for coordinating both medical and dental insurance claim filings including authorizations, submission, tracking, payment posting, allocation, and appeal of denials. Submission and tracking of pre-determinations and prior authorizations for both commercial and government carriers. Establish and maintain contact with third party pay (insurance) providers to be aware of process, qualifications, and coverage changes. Counsel patients, students, faculty, and staff regarding third party coverage.
Primary Duties and Responsibilities:
Manage and refile denied insurance claims with required additional information to insurance, Medicaid, Federal Grants, Medicare and other third party payers. Contact providers, students and/or clinics regarding claims to obtain additional information and work account to resolution. Post insurance payments and EOBs, allocation of insurance payments, and transfer balances to patient when appropriate. Verify Medicaid eligibility daily for all IUSD patients including offsite locations. Advise students if services will not be covered and Medicaid waiver requirements. Verify/load insurance as well as rebill any unpaid claims for all IUSD locations. Serve as support for student, patients, staff, and faculty via internal messaging system.
Submission and appeal of medical and dental pre-authorizations which requires challenging of the initial denial and/or submission of additional information to support claim. Review EOBs for government carriers to ensure appropriate waivers are signed. Learn all government packages of Medicaid and the services that are covered by each package including prior auth requirements for each package.
Run, analyze reports, and implement solutions on insurance accounts receivable to improve collection on unpaid or incomplete claims from insurance, Medicaid, Federal Grants, Medicare and other third party payers. Customer service including participation in telephone phone tree and rotation to off-site locations approximately every 6-8 weeks. Run and analyze EDI (electronic billing) reports and make determination of accounts that need to be converted. Contact third party payers regarding changes in coverage and billing processes. Counsel patients, faculty, students, and staff regarding third party coverage. Other projects as assigned.
REQUIRED: High School or GED, plus 2-3 years' experience with medical and dental third party billing. Must have Up-to-date immunizations and annual TB testing.
Knowledge, skills, and abilities: Strong customer service, attention to detail and organization skills. Effective communication skills. Ability to manage time and work on multiple projects effectively. Ability to effectively interact daily with patients, co-workers, doctors, dentists and insurance companies.
Previous medical and/or dental billing software experience. Coding specialist.
Working Conditions/Physical Demands:
Regular attendance. Must be able to remain in a stationary position for 90% of the time. Most of the shift will be spent on the phone and/or using a computer. Must be able to communicate with patients, students, staff, faculty, and insurance company representatives on the phone, via messenger, and/or via email. Must be able to review billing information. Must be able to operate a computer, phone, copier, and scanner.
Founded in 1820, Indiana University is the state’s public university system, comprised of two core campuses—IU-Bloomington and IUPUI—and six regional campuses located throughout the state. Combined, the total student population is more than 114,000 undergraduate, graduate and professional school students. IU is one of the largest employers in the state, with over 20,000 faculty and staff. Indiana University is an equal employment and affirmative action employer and a provider of ADA services. Diversity and inclusion remains a core commitment to IU’s mission to cultivate an educational environment that supports equal access, participation and representation on all of its campuses and that provides educational and career opportunities for all.