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Account Representative II - Medicaid Billing
| Company: | Medical College of Wisconsin Company Profile | Current Opportunities (136) |
| Job Location(s): | Brookfield, Milwaukee, Wauwatosa |
| Employment Term: | Regular |
| Employment Type | Full Time |
| Start Date: | ASAP |
| Starting Salary Range: | Not Provided |
| Required Education: | High School or Equivalent |
| Required Experience: | 1 to 20+ years |
| Related Categories: | Healthcare - Administration/Billing, Admin - Data Entry/Billing |
Position Description
POSITION PURPOSE
To submit, post, and/or 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.
ESSENTIAL DUTIES
1. Apply extensive knowledge of multiple contracts, agreements and government guidelines/regulations to submit, post, research and/or resolve accounts or claims. Phone contact with various representatives, both internal and external is necessary.
2. 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 carriers’ requests for additional information or documentation. Review carriers’ denials and/or unacceptable reimbursement to (a) challenge the determination or(b) adjust appropriately.
3. Review and update registration to correspond with information received from payer.
4. Copy and forward remittance advice to appropriate team for follow-up.
5. Responsible for identifying and escalating contractual/carrier issues to the appropriate source.
6. Assist in training of Clerks. Perform necessary billing activities such as claims to maintain team goals or assist other teams.
OTHER DUTIES
Perform other duties as assigned.
MINIMUM POSITION QUALIFICATIONS
Appropriate education and/or experience may be substituted on equivalent basis
Education: High School Diploma
Experience: One year of medical billing, payment posting, claims, or account follow-up
Experience required.
Certifications/Licenses: None
KNOWLEDGE, SKILLS, & ABILITIES
Basic knowledge of CPT-4 and ICD-9. Ability to work on multiple tasks in a high volume environment. Ability to work with minimal supervision. Strong interpersonal, organizational and communication skills are necessary. Medical terminology experience preferred, basic word-processing and spreadsheet applications.
To submit, post, and/or 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.
ESSENTIAL DUTIES
1. Apply extensive knowledge of multiple contracts, agreements and government guidelines/regulations to submit, post, research and/or resolve accounts or claims. Phone contact with various representatives, both internal and external is necessary.
2. 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 carriers’ requests for additional information or documentation. Review carriers’ denials and/or unacceptable reimbursement to (a) challenge the determination or(b) adjust appropriately.
3. Review and update registration to correspond with information received from payer.
4. Copy and forward remittance advice to appropriate team for follow-up.
5. Responsible for identifying and escalating contractual/carrier issues to the appropriate source.
6. Assist in training of Clerks. Perform necessary billing activities such as claims to maintain team goals or assist other teams.
OTHER DUTIES
Perform other duties as assigned.
MINIMUM POSITION QUALIFICATIONS
Appropriate education and/or experience may be substituted on equivalent basis
Education: High School Diploma
Experience: One year of medical billing, payment posting, claims, or account follow-up
Experience required.
Certifications/Licenses: None
KNOWLEDGE, SKILLS, & ABILITIES
Basic knowledge of CPT-4 and ICD-9. Ability to work on multiple tasks in a high volume environment. Ability to work with minimal supervision. Strong interpersonal, organizational and communication skills are necessary. Medical terminology experience preferred, basic word-processing and spreadsheet applications.
