Duties:

Analyze , process and adjust paper & electronic claims for accuracy. Reviews case specific information to enter the prior approval for claim adjudication. Resolve complex collections, provider and customer complaints independent of manager oversight. Train providers to use the Provider Portal application and provides instructions on procedures and policies for claims adjudication. Determines the policy provision for complex nursing and medical claims. Communicates findings with DSCC staff and providers. Determines a resolution to process the claim. Reviews and analyzes provider claims and insurance explanation of benefits for quality assurance. Initiates, receives and documents telephone calls to facilitate claims payment process. Serves as the primary point of contact for providers, DSCC staff and families in various situations. Determines appropriate adjustments needed when explanation of benefit's, refund checks or claims are resubmitted by providers or families. Attends Division and university related meetings and serves as a departmental liaison in the absence of the manager. Trains new and lower level staff on unit policies and procedures, including processing of claims. Reports and training issues to claims manager. Identifies needs/problems with computer software programs and agency claims processing practices, makes recommendations for change or enhancement to manager. Conducts file audits to obtain reimbursement of DSCC expenditures due to benefit coverage changes, claims processed incorrectly by insurance carriers and discrepancies of insurance benefit coverage. Prepares reports or written correspondence for the manager as requested. Assists manager on revisions to the Home Care and Core Department Manual. May supervise lower level staff as assigned in the absence of the department manager. Conducts quarterly quality assurance audits on finalized claims based on departmental guidelines. Other duties as assigned. This position is based out of DSCC office location in Springfield, IL. This position may have the option to work from home on most days while traveling into the office or to events as needed. We offer a very competitive benefits package: State of IL employee health/vision/dental, starting accrual of 5 weeks' vacation/year, over a dozen paid holidays, and a dozen sick days. Retirement is through the State Universities Retirement System. For full consideration, all applicants must apply on the UIC Job Board located at: https://uic.csod.com/ux/ats/careersite/1/home/requisition/20472?c=uic All application materials must be received by 8/2/2026.

Qualifications:

Any one or any combination that equals two (2) years (24 months) from the categories below: Experience within a health insurance/medical billing environment or in other positions of comparable responsibility within the health insurance area College credit for course work in insurance/benefits administration, human resource management, health information management, finance, accounting or closely related fields such as business administration and/or business management 30 semester hours equals (6) months 60 semester hours equals (1) year (12 months) 90 semester hours equals (2) years (24 months) 120 semester hours or higher equals (3) years (36 months)

Note:

the following medical billing certifications satisfy (6) months of the above requirement:

CPC, RHIT, CCS, RHIA, NHA

The University of Illinois System is an equal opportunity employer, including but not limited to disability and/or veteran status, and complies with all applicable state and federal employment mandates. Please visit Required Employment Notices and Posters to view our non-discrimination statement and find additional information about required background checks, sexual harassment/misconduct disclosures, and employment eligibility review through E-Verify. The university provides accommodations to applicants and employees. Request an Accommodation Artificial Intelligence (AI) tools may be used in some portions of the candidate review process for this position, however, all employment decisions will be made by a person.

Job Type:

Full-time Pay:

$40,891.00 - $47,101.00 per year

Benefits:

Dental insurance Disability insurance Employee assistance program Employee discount Flexible schedule Flexible spending account Health insurance Health savings account Life insurance Paid time off Professional development assistance Retirement plan Tuition reimbursement Vision insurance

Education:

High school or equivalent (Required)

Experience:

Insurance verification: 1 year (Required) Medical billing: 1 year (Required)

Work Location:

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