Account Representative II, HMO - Clinical Practice Services

Hybrid position: 90% Remote, 10% Onsite. Must live in the Metro Milwaukee, WI area.

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.
• 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 in training Clerks.
• Perform necessary billing activities such as claims to maintain team goals or assist other teams.
• Other duties as assigned.

Requirements

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

Qualifications

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

Benefits

• 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
• 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.

At MCW, all endeavors are driven by shared organizational values: Caring, Collaborative, Curiosity, Inclusive, Integrity, and Respect. We are committed to fostering an inclusive environment that values diversity in backgrounds, experiences, and perspectives.