Account Rep II, HMO - Clinical Practice Services

About the role

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.

Requirements

• 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.
• #LI-RT1
• 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
• MCW as an Equal Opportunity Employer and Commitment to Non-Discrimination:

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