Account Credit Resolution Representative II

Position Description:

Every day, in ways both big and small, the Medical College of Wisconsin (MCW) is impacting lives for the better. MCW ... changemaking for a healthier Wisconsin.

The Credit Resolution team is responsible to review all unresolved credits and provider level adjustment on professional billing invoices. The team is also responsible to complete internal/external account charge correction requests. All tasks are to be facilitated in accordance with CPS refund policies, governmental regulations and guidelines, and multiple MCW contractual agreements with various insurance carriers.

Hybrid Position: 90% Remote & 10% Onsite

Responsibilities:

• Audit and verify incorrect payment allocation, duplicate payment of service, and payments made to MCW & CP in error. Re-allocate, correct, or refund upon completion of audit.
• Review credits on patient account invoices and utilize internal and external resources and/or call insurance company to retrieve appropriate remittance advice (EOB) for further credit review and determination.
• Reconcile refund request reports generated within team.
• Post and link refund request letters to corresponding invoice
• Review Provider Level Adjustment WQ (PLB) for account/remittance resolution.
• Complete Epic charge corrections on patient accounts based upon request from internal and external departments.
• Apply all CPS refund policies, governmental guidelines, and MCW contractual agreements to determine appropriate action in each situation.
• Provide assistance to the Accounting team and the Posting team as required.
• Complete special projects as assigned by Supervisor.

Knowledge - Skills - Abilities

Medical insurance billing, reimbursement procedures, and payment allocation. Epic software application and CPT-4 and ICD-9 coding regulations knowledge. Computer knowledge in Windows and Microsoft applications.
Knowledge of quality control, customer service standards, information management, procedural process, and recordkeeping.
Computer, technical, interpersonal and oral communication 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: 2 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: 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. For more information, please visit our institutional website at https://www.mcw.edu/departments/office-of-diversity-and-inclusion.

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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