Account Rep II, Commercial - Clinical Practice Services

Summary

Account Rep II on the Commercial team responsible for submitting, posting, and securing maximum allowable reimbursement from third-party carriers, government programs, and Health Maintenance Organizations in claims submission and account follow-up. Requires extensive use of multiple internal and external computer systems and contact with carriers. Hybrid position: 90% Remote, 10% Onsite; location must be within the Metro Milwaukee, WI area.

• 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 the appropriate team for follow‑up.
• Identify 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.

• Minimum Required
  
  Education:
  
  High school diploma.
• Minimum
  
  Required Experience:
  
  3 years.
• Preferred Experience:
  
  Customer Service and/or Medical Billing experience (#LI-RT1).

• Knowledge of quality control, customer service standards, information management, procedural process, and recordkeeping.
• Computer, technical, interpersonal, oral communication, listening, and patience skills.

• Outstanding healthcare coverage including health, vision, and dental.
• Flexible Spending Accounts.
• 403(b) retirement package.
• Competitive vacation and paid holidays.
• Tuition reimbursement.
• Paid parental leave.
• Employee & Family Assistance Program (EFAP).
• Pet insurance.
• On‑campus fitness facility with onsite classes.
• Discounted rates on select cell phone plans, local fitness facilities, Milwaukee recreation, and entertainment.

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, and to 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 may not be subjected to harassment that is prohibited by law or treated adversely or retaliated against based upon a protected characteristic.