The incumbent in the position processes preauthorizations/precertifications forms for the
Department of Surgery. This person will assist in maintaining a departmental managed care
manual as well as updating faculty and staff in the department regarding changes in the
managed care process. This person will interact with physicians, nurses, and secretarial staff in
the Department of Surgery as well as insurance companies, patients, and other departments or
clinic areas.

Preauthorization/Precertification 85%
A. Verifies accuracy of billing codes of routine, non-complex medical health claims related
to processing of pre-authorizations/precertification's of patient procedures (e.g.,,
diagnostic tests ,inpatient and outpatient surgery, rehab and DME). This involves
discussion with physician or nurse, reviewing the patient's medical record for necessary
documentation and disseminating the appropriate information to the managed
care/insurance company in order to secure approval of patient procedures.
B. Provide faculty and staff with updates regarding changes made to managed
care/insurance procedures and/or protocols.
C. Assist in maintenance of a central resource manual of managed care/insurance
company plans.
D. Respond to routine, non-complex inquiries from physicians, nurses, hospitals,
government agencies, insurance companies, managed care companies and patients
concerning requests for assistance to assure appropriate coverage for planned medical
services.
E. Receive and respond to patient calls regarding insurance questions, precerts,
authorizations, etc.
F. Identifies, analyzes and takes necessary action in the review of insurance denials in
order to determine the appropriate course of action required to accurately complete
the medical review process.
G. Secure additional health information from the patient and/or physician regarding the
episode of care being denied and initiate follow-up discussions with insurance
organizations in order to obtain a medical review.
H. Correspond with physician, nurses, hospitals, government agencies, insurance
companies, managed care companies, and patient as required to identify and collect
the information required to complete the authorization process.
I. Obtain standard, established codes acquired from ICD-9 and CPT coding books after
chart review and/or discussion with physician or nurse and disseminate to the certifying
insurance agency.
J. Maintain accurate records of preauthorization/precertification process through
entering appropriate information into computerized system.
K. Create computerized precertification forms to make the process more efficient.

II. Administrative 15%
A. Attend training sessions, meetings, and conferences and read publications to remain
current on the policies and procedures of managed care/insurance companies.
B. Participate in SIU Physicians & Surgeons committees as requested.
C. Other duties/projects as assigned.

a. Experience within a health insurance/medical billing environment; or

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)); or

If you require assistance, please contact the Office of Human Resources at or call 217-545-0223 Monday through Friday, 8:00am-4:30pm.

The mission of Southern Illinois University School of Medicine is to optimize the health of the people of central and southern Illinois through education, patient care, research and service to the community.

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"Jeanne Clery Disclosure of Campus Security Policy and Crime Statistics Act."

Southern Illinois University School of Medicine is an Affirmative Action/Equal Opportunity employer who provides equal employment and educational opportunities for all qualified persons without regard to race, color, religion, sex, national origin, age, disability, sexual orientation, protected veteran status or marital status in accordance with local, state and federal law.

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