Account Rep II, Medicare - Clinical Practice Services

The Medical College of Wisconsin•Wauwatosa, WI

2d•Hybrid

About The Position

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.

Requirements

High school diploma
3 years of experience
Knowledge of quality control, customer service standards, information management, procedural process, and recordkeeping.
Computer, technical, interpersonal, oral communication, listening, and patience skills.

Nice To Haves

Customer Service and/or Medical Billing experience.
EPIC experience preferred.

Responsibilities

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.

Benefits

Outstanding Healthcare Coverage, including but not limited to Health, Vision, and Dental.
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.