Medical Insurance Verification Jobs in Springfield, IL

Salary: $18.70 - $20.57 Hourly
Location : Springfield, IL
Job Type: Civil Service
Job Number: 2402192
Department: Internal Medicine Clinic-SMS
Division: Clinical
Opening Date: 07/14/2026
Closing Date: 7/20/2026 2:00 PM Central
FLSA: Non-Exempt
Bargaining Unit: AFSCME Local 370
Shift: Days
ExemptorNon_Exempt: Non-Exempt
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Description
The primary function is to perform duties and responsibilities for the Department of Medicine outpatient clinic. Specifically, this position is to assist patients in receiving the services and tests needed and to ensure that proper procedures are followed in compliance with the various insurance companies to ensure payment of those services. This position works under general supervision and acts as a resource specialist within the Department of Internal Medicine for related clinical staff.
Examples of Duties
Insurance Duties 80%
1. Independently initiates and completes managed care referrals/pre-authorizations as indicated by patients' needs and insurance requirements in order to secure approval for the patient's ongoing medical care. Enters referrals in the SMS system and links to appropriate appointments.
2. Reviews patient medical records for necessary documentation and disseminates the appropriate information to the managed care organizations in order to secure approval of the referrals.
3. Schedules patients' tests, procedures and referrals to specialty offices through phone calls and EHR to the proper hospital/specialist according to physician orders and the patient's insurance.
4. Prepares lab orders, assigns insurance codes and faxes orders and all necessary information to facility prior to scheduled test.
5. Calls patients to relay dates, times and special instructions for tests and referral appointments. Documents required information into the electronic health record.
6. Acts as liaison and advisor for patients, physicians, hospitals, insurance companies, government agencies and related interested parties regarding proper documentation, referral requests, authorization procedures and verification of factual information regarding patient's insurance and other sensitive issues within the field.
7. Secures additional health information from the patient and/or physician's office as needed, and initiates follow-up discussions with the managed care organizations in order to obtain a review of referrals for medical care. Assigns insurance codes to documentation to ensure proper level of payment.
8. Serves as a patient advocate in obtaining referrals to specialist physicians and health care agencies in a timely manner and directs patients to preferred hospital, laboratory, or agency where appropriate.
9. Reviews and analyzes processing procedures in order to identify potential problem areas and improve processing procedure.
10. Acts as an expert resource on managed care issues. Responds to a variety of questions from patients, nursing staff, physicians, hospitals, and insurance companies concerning the status of referrals and scheduled tests.
Administrative 20%
1. Attends training sessions and conferences to remain current regarding policies and procedures of managed care insurance; attends monthly SIU Managed Care Networking Group meetings to keep abreast of changes.
2. Maintains current information on all participating managed care plans in the clinic area including procedures, coding, etc.
3. Participates in the development of appropriate forms for internal and external use as they relate to referrals.
4. Participates on DGIM EHR team as it relates to the referral process.
5. Provides clinical staff and reception with updates on managed care plans.
Qualifications
Credentials to be Verified by Placement Officer:

1. Any one or combination totaling one (1) year (12 months) from the categories below:
   1. 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 one (1) year (12 months)
      • Associate's Degree (60 semester hours) equals eighteen months (18 months)
   2. Work experience in a healthcare environment working with medical claims, denials, rejections, referrals, and prior authorizations.

Knowledge, Skills and Abilities (KSA's):

1. Knowledge of principles and processes for providing customer and personal services. This includes customer needs assessment, meeting quality standards for services, and evaluating customer satisfaction.
2. Knowledge of the structure and content of the English language including the meaning and spelling of words, rules of composition, and grammar.
3. Knowledge of medical terminology and hospital or physician billing, coding, referrals, and prior authorizations.
4. Knowledge of basic arithmetic with the ability to add, subtract, multiply and divide whole numbers, decimals and percentages.
5. Skill in using computers and computer systems (including hardware and software) to program, write, set up functions, enter data, or process information.
6. Ability to pay close attention to details and follow established procedures in completing work tasks.
7. Ability to maintain patient confidentiality following HIPAA guidelines and established policies and procedures.
8. Ability to convey moderately complex billing, claims, referral, and prior authorization information to patients and staff.
9. Ability to train others to work collaboratively, building strategic relations with colleagues, coworkers, constituents.

Condition of Employment:
Pursuant to the State Universities Civil Service System, an out-of-state resident who is hired into this position must establish Illinois residency within 180 calendar days of their start date.
Supplemental Information
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.
The SIU School of Medicine Annual Security Report is available online at This report contains policy statements and crime statistics for Southern Illinois University School of Medicine in Springfield, IL. This report is published in compliance with Federal Law titled the
"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.
Pre-employment background screenings required.
Paid time off: Includes 12 paid holidays per year. Accrual rates vary based on employment type and years of service
Paid sick time: Use for personal illness, doctor visits, or if your immediate family members fall ill
Health, Dental, and Life insurance
Optional life insurance: Your spouse and dependents can enroll in State term life and university-sponsored term life insurance.
Prescription: Plan participants enrolled in any state health plan have prescription drug benefits included in the coverage.
Long-term Disability Insurance
Flexible spending accounts: Optional, IRS tax-favored program that enables you to stretch medical expenses and dependent care dollars
Voluntary retirement accounts: Optional plans include the State of Illinois Deferred Compensation Plan (457) and Tax Deferred Annuity (403b).
Tuition Waiver/Tuition Reimbursement: Continue your graduate or undergraduate education with the help of tuition waivers or tuition reimbursement
Leaves of absence: Includes FMLA and Extended Sick Leave Benefits for qualified employees
Employee Assistance Program: Access free and confidential support, including counseling services, and information during difficult times
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