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Account Rep II, Medicare – Clinical Practice Services
MCWAccount Rep II responsible for claims submission and securing reimbursements from insurers. Requires 3 years experience and high school diploma, based in Wisconsin.
About the role
Key responsibilities & impact- 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 Work Arrangement: 90% Remote, 10% onsite, must reside in the metro Milwaukee, WI area.
- 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.
Requirements
What you’ll need- Minimum Required Education: High school diploma
- Minimum Required Experience: 3 years
- Preferred Experience: Customer Service and/or Medical Billing experience.
- EPIC experience preferred.
Benefits
Comp & perks- Outstanding Healthcare Coverage, including but not limited to Health, Vision, and Dental.
- 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.
ATS Keywords
✓ Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills & Tools
Claims ProcessingAccount Follow-UpDocumentation AccuracyRemittance AnalysisContractual Guidelines
Soft Skills
CommunicationProblem-SolvingTeam Collaboration