Account Representative II, HMO - Clinical Practice Services

Medical College of Wisconsin • Milwaukee, WI

7d • Hybrid

About The Position

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. This is a hybrid position with 90% remote work and 10% onsite work, requiring the employee to live 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

• Medical Billing experience
• EPIC experience

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.
• 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 challenge the determination or adjust appropriately.
• Review and update registration to correspond with information received from payer.
• Copy and forward remittance advice to appropriate team for follow-up.
• Identify and escalate 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 Health, Vision, and Dental
• Flexible Spending options
• 403B Retirement Package
• Competitive Vacation
• Paid Holidays
• 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.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: High school or GED