Account Rep II, Medicare - Clinical Practice Services

Medical College of Wisconsin; Wisconsin; Hybrid; USD 42,000 - 62,000; Full time

Benefits offered by this job

Healthcare coverage

403B retirement

Tuition reimbursement

Paid parental leave

EFAP

Pet insurance

On campus fitness facility

Discounted rates

Job summary

Medical College of Wisconsin in Milwaukee, WI is seeking an Account Rep II to submit, post, and secure maximum reimbursements from third-party carriers, government programs, and HMOs within claims submission and follow‑up. The role requires extensive use of multiple systems and coordination with payers.

Hybrid work arrangement: 90% remote, 10% onsite, must reside in the metro Milwaukee area. Minimum 3 years’ experience and a high school diploma are required; EPIC experience is a plus.

Qualifications

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

Responsibilities

• Submit, post, and secure maximum reimbursement from third‑party carriers, government programs and HMO in claims submission and follow-up.
• Apply knowledge of contracts and government guidelines to submit, post, research, and resolve accounts or claims.
• Communicate via phone with insurance representatives.
• Analyze remittance sources to determine proper allocation of rejections, payments and adjustments.
• Respond to carrier information requests and review denials to challenge or adjust accordingly.
• Update registrations with payer information and forward remittance advice for follow‑up.
• Identify and escalate contractual carrier issues.
• Assist training Clerks and perform billing activities to maintain team goals.

Skills

Customer service

Communication skills

Billing knowledge

Education

High school diploma

Tools

EPIC experience

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.

Benefits

• 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.

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, and 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.