MCW: SARGEANT HEALTH CENTER Account Rep II HMO Team in MILWAUKEE, Wisconsin
JOB REQUIREMENTS: 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. Primary Functions 1. Apply extensive knowledge of multiple contracts, agreements and government guidelines/regulations to submit, post, research and/or resolve accounts or claims. 2. Communicate via phone with various representatives, both internally and externally is necessary. 3. Analyze multiple sources of remittance to determine proper allocation of rejections, payments and/or adjustments, subject to individual carrier guidelines and contractual fee schedules. 4. Respond to carrier requests for additional information or documentation. 5. Review carrier denials and/or unacceptable reimbursement to (a) challenge the determination or (b) adjust appropriately. 6. Review and update registration to correspond with information received from payer. 7. Copy and forward remittance advice to appropriate team for follow-up. 8. Responsible for identifying and escalating contractual carrier issues to the appropriate source. 9. Assist training Clerks. 10. Perform necessary billing activities such as claims to maintain team goals or assist other teams. EEO/AA - Minorities/Females/Vets/Disability The Medical College of Wisconsin is an affirmative action/equal opportunity employer and does not discriminate in hiring or employment on the basis of age, sex, race, color, religion, national origin, veteran status, disability or sexual orientation. ***** OTHER EXPERIENCE AND QUALIFICATIONS: Prior Experience: 3 years ***** APPLICATION INSTRUCTIONS: Apply Online: ipc.us/t/B62CFACFCB004AD0 Qualified females, minorities, and special disabled veterans and other veterans are encouraged to apply.