Quality Analyst I

Milwaukee, WI - USA

Monthly Salary: Not Disclosed

Posted on: 22 hours ago

Vacancies: 1 Vacancy

Job Summary

Position Description:
Account Rep II

Position Description:

Every great life-changing discovery begins the same waywith new knowledge. It can change everything from a single life to the future of entire communities. Thats 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 anAccount Rep IIyou 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.

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:

Position Requirements:

Specifications

Minimum Qualifications:

Appropriate experience may be substituted for education on an equivalent basis

Minimum Required Education: High school diploma

Minimum Required Experience: 3 years

#LI-RT1

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: a brief overview of our benefits see: Wisconsin isa vibrant diverse metropolitan area. MCWis 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 individuals 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.

Required Experience:

Position Description: Account Rep IIPosition Description:Every great life-changing discovery begins the same waywith new knowledge. It can change everything from a single life to the future of entire communities. Thats why academic medicine and the continuous pursuit of knowle...