Account Representative II HMO
4 weeks ago
Job Summary:
We are seeking a highly skilled Account Representative II HMO to join our team at MCW: SARGEANT HEALTH CENTER. The successful candidate will be responsible for submitting, posting, and securing maximum allowable reimbursement from third-party carriers, government programs, and Health Maintenance Organizations in the areas of claims submission and/or account follow-up.
Key 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, to resolve issues and provide excellent customer service.
- 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 and review carrier denials and/or unacceptable reimbursement to challenge the determination or adjust appropriately.
- Review and update registration to correspond with information received from payer and copy and forward remittance advice to appropriate team for follow-up.
- Identify and escalate contractual carrier issues to the appropriate source and assist training Clerks.
- Perform necessary billing activities such as claims to maintain team goals or assist other teams.
Requirements:
- High school diploma
- Minimum 3 years of experience in a related field
- Excellent communication and analytical skills
- Ability to work in a fast-paced environment and meet deadlines
Why Join Us:
MCW: SARGEANT HEALTH CENTER offers a competitive salary, outstanding healthcare coverage, flexible spending options, 403B retirement package, competitive vacation and paid holidays, tuition reimbursement, paid parental leave, pet insurance, and on-campus fitness facility with onsite classes. Additionally, we offer discounted rates on select cell phone plans and other benefits.
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