Account Rep II, Commercial - Clinical Practice Services

The Medical College of Wisconsin, Inc.; Wauwatosa (WI); Hybrid; USD 48,000 - 68,000; Full time

Benefits offered by this job

Health insurance

Dental insurance

Paid time off

Tuition reimbursement

Onsite fitness facility

Retirement plan

Job summary

The Medical College of Wisconsin, Inc. is seeking an Account Rep II to manage claims submission and posting to maximize reimbursements from third-party carriers and government programs.

The role requires extensive use of internal and external systems and interaction with payer entities, within a hybrid schedule (90% remote, 10% onsite) in the metro Milwaukee area. Responsibilities include handling requests for information, reviewing remittances, and resolving denials per carrier guidelines.

Qualifications

• High school diploma required; 3 years of relevant experience preferred.
• Customer service and medical billing experience preferred.
• EPIC experience preferred.

Responsibilities

• Submit, post, and secure maximum allowable reimbursement from third-party carriers and government programs.
• Release of information: pull medical records for claims payment and ensure documentation is present and accurate.
• Analyze remittance to determine proper allocation of rejections, payments and adjustments per carrier guidelines.
• Communicate with insurance representatives by phone as needed.
• Respond to carrier requests for additional information or documentation.
• Review denials and/or unacceptable reimbursement to challenge or adjust as appropriate.
• Update registrations to reflect payer information.
• Assist training Clerks and perform necessary billing activities.
• Escalate contractual carrier issues to the appropriate source.
• Other duties as assigned.

Skills

Customer service

Communication skills

Attention to detail

Interpersonal skills

Education

High school diploma

Tools

EPIC

Job description

SummaryAs 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 ResponsibilitiesRelease 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.Assist training Clerks.Perform necessary billing activities such as claims to maintain team goals or assist other teams.Other duties as assigned.Knowledge – Skills – AbilitiesKnowledge of quality control, customer service standards, information management, procedural process, and recordkeeping.Computer, technical, interpersonal, oral communication, listening, and patience skills.QualificationsMinimum Required Education: High school diplomaMinimum Required Experience: 3 yearsPreferred Experience: Customer Service and/or Medical Billing experience. EPIC experience preferred.#LI-RT1Why MCW?Outstanding Healthcare Coverage, including but not limited to Health, Vision, and Dental. Along with Flexible Spending options403B Retirement PackageCompetitive Vacation and Paid Holidays offeredTuition ReimbursementPaid Parental LeaveEmployee & Family Assistance Program (EFAP)Pet InsuranceOn campus Fitness Facility, offering onsite classesAdditional 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 OverviewFor a full list of positions see: MCW CareersAt MCW all of our endeavors, from our internal operations to our interactions with our partners, are driven by our shared organizational values: Caring – Collaborative – Curiosity – Inclusive – Integrity – Respect. We are committed to fostering an inclusive environment that values diversity in backgrounds, experiences, and perspectives through merit-based processes and in alignment with all applicable laws. We believe that embracing human differences is critical to realize our vision of a healthier world, and we recognize that a healthy and thriving community starts from within. Our values define who we are, what we stand for and how we conduct ourselves at MCW. If you believe in embracing individuality and working together according to these principles to improve health for all, then MCW is the place for you. For more information, please visit our institutional website.MCW as an Equal Opportunity Employer and Commitment to Non-Discrimination:The Medical College of Wisconsin (MCW) is an Equal Opportunity Employer. We are committed to fostering an inclusive community of outstanding faculty, staff, and students, as well as ensuring equal educational opportunity, employment, and access to services, programs, and activities, without regard to an individual's race, color, national origin, religion, age, disability, sex, gender identity/expression, sexual orientation, marital status, pregnancy, predisposing genetic characteristic, or military status. Employees, students, applicants or other members of the MCW community (including but not limited to vendors, visitors, and guests) may not be subjected to harassment that is prohibited by law or treated adversely or retaliated against based upon a protected characteristic.