Account Rep II, HMO - Clinical Practice Services

Account Rep II

As an Account Rep II on the HMO 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 Position: 90% Remote & 10% Onsite, must live 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/Follow-Up 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 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.