Account Rep II, Commercial - Clinical Practice Services

The Medical College of Wisconsin, Inc.; Wisconsin; Hybrid; USD 45,000 - 65,000; Full time

Benefits offered by this job

Health Insurance

Vision Insurance

Dental Insurance

403B Plan

Paid Holidays

Tuition Reimbursement

Parental Leave

Pet Insurance

Onsite Fitness

Job summary

The Medical College of Wisconsin seeks an Account Rep II on the Commercial team to optimize payer reimbursements across third-party carriers, government programs, and HMOs. Hybrid work arrangement: 90% remote, 10% onsite in the Milwaukee metro area.

Responsibilities include releasing information, pulling medical records, and ensuring documentation meets contract and government guidelines. Strong communication and multi-system navigation are essential.

Qualifications

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

Responsibilities

• Submit, post, and secure reimbursement from third‑party carriers and government programs.
• Analyze remittance and carrier denials to determine proper payments.
• Communicate with insurance representatives by phone to resolve accounts.
• Release of information and maintain accurate documentation.
• Assist training Clerks and support billing activities.

Skills

Quality control knowledge

Customer service

Information management

Procedural processes

Recordkeeping

Communication skills

Interpersonal skills

Patience

Education

High school diploma

Job description

Summary 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. Assist training Clerks. 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. #LI-RT1

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 Paid Parental Leave 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 At 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.

About Us

Together, we can build a healthier world. A student, an educator, a scientist and a community leader — alone, they can do many things. Together, the question isn’t what they can do, but what can’t they. The Medical College of Wisconsin (MCW) brings together the most inquisitive, passionate minds in science, medicine, education and community engagement to tackle today’s toughest challenges in health and society. Academic medicine is at the center of where scientists, physicians and students work hand‑in‑hand with the community to ask the most important questions and fuel the cycle of innovation that shapes the future of medicine. Medical College of Wisconsin The tireless pursuit of knowledge and the power of academic medicine is at the core of everything we do at MCW. Bringing together the world’s top scientists and clinicians, inspired students and invested communities, we are driven to solve the most complex challenges in health and society. With around 1,600 full‑time and part‑time faculty and approximately 3,500 full‑time employees, MCW is home to a diverse group of thought leaders working in collaboration to pioneer pathways to a healthier world and drive a continuous cycle of life‑changing discovery.