Account Rep II - HMO

Position Description :

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 Position : 90% Remote & 10% Onsite

Responsibilities :

• 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 as 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 registration and update corresponding Department 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 Account Rep I.
• Perform necessary billing activities such as claims to maintain team goals or assist other teams.
• Works special projects as assigned by supervisor.

Knowledge - Skills - Abilities

Preferred Schedule :

Full-time role with expectations for coverage during core business hours and flexibility required as necessary to accommodate business needs.

Position Requirements :

Minimum Qualifications :

Appropriate experience may be substituted for education on an equivalent basis

Minimum Required Education : High school diploma

Minimum Required Experience : 2 years

Preferred Qualifications :

Preferred Experience : Customer Service and / or Medical Billing experience.

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Why MCW?

For a full list of positions see : www.mcw.edu / careers

For a brief overview of our benefits see : https : / / www.mcw.edu / departments / human-resources / benefits

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.