Account Rep II, Commercial

About the role

As an Account Rep II on the Commercial 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.

Responsibilities

• Reply to requests for information from insurance companies and pull the appropriate medical records to submit for claims payment, ensuring 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 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 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.
• Perform other duties as assigned.

Qualifications

• Minimum Required Education: High school diploma
• Minimum Required Experience: 3 years
• Preferred Experience: Customer Service and/or Medical Billing experience; EPIC experience preferred

Skills

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

Benefits

• Outstanding Healthcare Coverage, including but not limited to Health, Vision, and Dental.
• Flexible Spending options.
• 403B Retirement Package.
• Competitive Vacation and 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.

Schedule

Hybrid Work Arrangement: 90% Remote, 10% onsite; must reside in the metro Milwaukee, WI area.