Account Rep II, Medicare - Clinical Practice Services

Medical College of Wisconsin; Madison (WI); Hybrid; USD 42,000 - 65,000; Full time

Benefits offered by this job

Health coverage and vision

Dental coverage

403B retirement package

Paid vacation and holidays

Tuition reimbursement

Parental leave

Pet insurance

On-site fitness facility

Employee discounts

Job summary

Medical College of Wisconsin is seeking an Account Rep II to submit, post, and maximize reimbursement from third-party carriers and government programs. The role involves extensive use of multiple systems and contact with payers.

A hybrid work arrangement is offered: 90% remote and 10% onsite in the Milwaukee metro area. Responsibilities include reviewing remittance, handling denials and adjustments, updating payer registrations, and assisting training Clerks.

Qualifications

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

Responsibilities

• Release of information: Reply to requests for information from insurance companies and pull medical records for claims submission.
• Apply knowledge of contracts, agreements and government guidelines to submit, post, research and resolve accounts or claims.
• Communicate via phone with internal and external representatives.
• Analyze remittance sources to determine proper allocations per carrier guidelines.
• Respond to carrier requests for additional information or documentation.
• Review denials and adjustments and challenge or adjust as needed.
• Update registrations to reflect payer information received.
• Distribute remittance advice to the appropriate team for follow-up.
• Identify and escalate contractual carrier issues.
• Assist training Clerks.
• Perform billing activities to maintain team goals.
• Other duties as assigned.

Skills

Customer service

Interpersonal skills

Communication

Recordkeeping

Quality control

Education

High school diploma

Tools

EPIC

Job description

Summary

As an Account Rep II, 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.

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 LeaveEmployee & 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.

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.