Account Rep II - Anthem

Position Description:

Every great life-changing discovery begins the same way-with new knowledge. It can change everything, from a single life to the future of entire communities. That's why academic medicine, and the continuous pursuit of knowledge, is at the center of everything we do at the Medical College of Wisconsin (MCW).

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 Position: 90% Remote & 10% Onsite

Responsibilities:

• 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.

Knowledge - Skills - Abilities

Knowledge of quality control, customer service standards, information management, procedural process, and recordkeeping.

Computer, technical, interpersonal, oral communication, listening, and patience skills.

Preferred Schedule:



Full-time role with expectations for coverage during core business hours and flexibility required as necessary to accommodate business needs.

Position Requirements:

Minimum Qualifications:

Appropriate experience may be substituted for education on an equivalent basis

Minimum Required Education: High school diploma

Minimum Required Experience: 3 years

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Why MCW?

• 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 offered
• Tuition Reimbursement
• Paid Parental Leave
• 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.

For a full list of positions see: www.mcw.edu/careers

For a brief overview of our benefits see: https://www.mcw.edu/departments/human-resources/benefits

Eastern Wisconsin is a vibrant, diverse metropolitan area. MCW is intent on attracting, developing, and retaining a diverse workforce and faculty body that reflects the community we serve. We value diversity of backgrounds, experience, thought, and perspectives to advance excellence in science and medicine. MCW is a welcoming campus community with a strong culture of collaboration, partnership, and engagement with our surrounding community.

MCW as an Equal Opportunity Employer and Commitment to Non-Discrimination


The Medical College of Wisconsin (MCW) is an Equal Opportunity Employer. We are committed to fostering a diverse community of outstanding faculty, staff, and students, as well as ensuring equal educational opportunity, employment, and access to services, programs, and activities, without regard to an individual's race, color, national origin, religion, age, disability, sex, gender identity/expression, sexual orientation, marital status, pregnancy, predisposing genetic characteristic, or military status. Employees, students, applicants or other members of the MCW community (including but not limited to vendors, visitors, and guests) may not be subjected to harassment that is prohibited by law or treated adversely or retaliated against based upon a protected characteristic.

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