Account Rep II, Commercial

Medical College of Wisconsin; Wauwatosa (WI); Hybrid; USD 42,000 - 64,000; Full time

Benefits offered by this job

Health coverage

403B retirement package

Vacation and holidays

Tuition reimbursement

EFAP

Pet insurance

On campus fitness facility

Discounted rates on local services

Job summary

Medical College of Wisconsin in the Milwaukee metro area seeks an Account Rep II on the Commercial team to submit, post, and secure maximum reimbursements from third-party carriers and government programs. You will handle claims and follow-up across multiple systems, ensuring accuracy and compliance with payer requirements.

The role is a hybrid work arrangement (90% remote, 10% onsite) and requires residing in the metro Milwaukee, WI area.

Qualifications

• High school diploma required.
• Minimum 3 years of experience.
• Preferred: Customer Service and/or Medical Billing experience; EPIC experience preferred.

Responsibilities

• Release of information: reply to requests for information from insurance companies and pull records for claims submission.
• Submit, post, and research accounts or claims using multiple contracts and government regulations.
• Communicate via phone with internal and external representatives as needed.
• Analyze remittance sources to allocate rejections, payments, and adjustments per carrier guidelines.
• Respond to carrier requests for additional information or documentation.
• Review denials and adjust or challenge determinations as appropriate.
• Update registrations to align with payer information.
• Copy and forward remittance advice to the appropriate team for follow-up.
• Identify and escalate contractual carrier issues to the proper source.
• Perform billing activities to support team goals and assist other teams.
• Other duties as assigned.

Skills

Quality control

Customer service

Information management

Procedural knowledge

Recordkeeping

Oral communication

Listening

Patience

Education

High school diploma

Tools

EPIC

Job description

As an Account Rep II on the Commercial team, you will submit, post, and secure maximum allowable reimbursement from third-party carriers, government programs and Health Maintenance Organizations in the areas of claims submission and/or account follow-up. Requires extensive use of multiple internal and external computer systems/applications and contact with the above entities.

Hybrid Work Arrangement: 90% Remote, 10% onsite, must reside in the metro Milwaukee, WI area.

Primary Responsibilities

• Release of information: Reply to requests for information from insurance companies. Pull the appropriate medical records to submit for claims payment and ensure all proper documentation is present and accurate.
• Apply extensive knowledge of multiple contracts, agreements and government guidelines/regulations to submit, post, research and/or resolve accounts or claims.
• Communicate via phone with various representatives, both internally and externally is necessary.
• Analyze multiple sources of remittance to determine proper allocation of rejections, payments and/or adjustments, subject to individual carrier guidelines and contractual fee schedules.
• Respond to carrier requests for additional information or documentation.
• Review carrier denials and/or unacceptable reimbursement to (a) challenge the determination or (b) adjust appropriately.
• Review and update registration to correspond with information received from payer.
• Copy and forward remittance advice to appropriate team for follow-up.
• Responsible for identifying and escalating contractual carrier issues to the appropriate source.
• Perform necessary billing activities such as claims to maintain team goals or assist other teams.
• Other duties as assigned.

Knowledge – Skills – Abilities

• Knowledge of quality control, customer service standards, information management, procedural process, and recordkeeping.
• Computer, technical, interpersonal, oral communication, listening, and patience skills.

Qualifications

Minimum Required Education: High school diploma

Minimum Required Experience: 3 years

Preferred Experience: Customer Service and/or Medical Billing experience. EPIC experience preferred.

Why MCW?

• Outstanding Healthcare Coverage, including but not limited to Health, Vision, and Dental. Along with Flexible Spending options
• 403B Retirement Package
• Competitive Vacation and Paid Holidays offered
• Tuition Reimbursement
• Employee & Family Assistance Program (EFAP)
• Pet Insurance
• On campus Fitness Facility, offering onsite classes
• Additional discounted rates on items such as: Select cell phone plans, local fitness facilities, Milwaukee recreation and entertainment etc.

For a brief overview of our benefits see: Benefits Overview

For a full list of positions see: MCW Careers