Account Research Rep II

Position Description:

Purpose

Provide support to Account Research area of the billing office especially in the Oracle system.  Audit patient accounts for appropriate reimbursement, adhering to CPS refund policies, governmental regulations and guidelines, and multiple MCW contractual agreements with various insurance carriers.

Primary Functions

  •  Process refund information extracted from IDX BAR system by Account Research staff into the Oracle system.

  •  Analyze patient accounts to retrieve appropriate payment copy information for Account Research Team.

  •  Reconcile special reports generated within team.

  •  Produce monthly Oracle reports for MCW Finance Department.  Work Charge Error and Do Not Bill Reports.

  •  Audit and verify incorrect payment allocation, duplicate payment of service, and payments made to MCW in error.  Re-allocate, correct, or refund upon completion of audit.

  •  Apply all CPS refund policies, governmental guidelines, and MCW contractual agreements to determine appropriate action in each situation.

  •  Possess a complete knowledge of the AES refund application in order to process refunds within IDX.

  •  Audit the accuracy of a money move or miscellaneous write-off requests to ensure that the correct level of authorization was provided.

  •  Provide assistance to the Accounting team and the Posting team as required.

Preferred Schedule:

Position Requirements:

Knowledge – Skills – Abilities

Medical insurance billing, reimbursement procedures, and payment allocation. IDX 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, oral communication, listening, and patience skills.

Organizational Structure

Building:  

Department:  

Division:  

Reports to (Title):  

Direct Reports (Titles):  

Collaborates with (Titles):  

Specifications

Appropriate experience may be substituted for education on an equivalent basis

Minimum Required Education:                High school diploma

Minimum Required Experience:              3 years

Preferred Education:  

Preferred Experience:                           

Field:                                                   

Certification:                                         

Classification

Grade Name                                         7       

Full-Time Equivalent                              1.0

FLSA Status                                   Non-Exempt

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

Job ID                                           331

Job Name                                      Administrative Support Grade 8 and Up

Position Category                             Clinical Management Services

Job Scope

Complexity – some initiative and occasional judgment required

Impact – errors may cause minor damage; work requires regular attention to accuracy

Autonomy – performs work without constant supervision; expected results are specifically outlined

Communication – proactively provides information to others; ensures appropriate dissemination of information

Responsibility – assists others to ensure proper completion of work

Confidentiality – supervised when working with confidential information

Leadership – may provide periodic training or assistance to others

Physical Requirements

Work requires occasionally lifting moderate weight materials, standing, or walking continuously.

Risk Potential

Little or no exposure to hazards such as dust, fumes, or extreme temperatures, airborne or blood borne pathogens, extreme temperatures, or allergens.

Sensory Acuity

Ability to detect and translate speech or other communication required. May occasionally require the ability to distinguish colors and perceive relative distances between objects.

Work Environment

Occasional exposure to dust, noise, temperature changes, or contact with water or other liquids. Work is performed in an environmentally controlled environment.

Performance Dimensions

Collegiality

Exhibit confidentiality, honesty, and actions that build trust and strengthen relationships. Listen to others and effectively communicate in a clear and concise manner through written and verbal communication. Demonstrate respect and commitment to the values of diversity and equity; seek out and incorporate diverse perspectives into decision making.

Excellence and Creativity

Exhibit initiative and ingenuity by taking ownership of tasks to proactively improve services, avoid problems, or develop opportunities. Generate novel and valuable ideas to impact institutional missions.

Identify and implement new methods to increase efficiency and quality.

Education and Development

Displays an ongoing commitment to continuous learning and self-improvement in one's area of responsibility. Actively seek out mentorship and learning opportunities that can be applied to current and future work activities. Develop and maintain professional affiliations. Participate in design, development, and/or evaluation of instructional materials, methods, courses, or programs.

Agility and Judgment

Remain flexible and versatile in rapidly changing environment and adapt quickly to changing circumstances. Change behavioral style or method of approach when necessary to achieve a goal. Make timely and sound decisions based on analysis of information, experience, and logic. Show reliability and accountability in the successful completion of all work.

Stewardship and Institutional Citizenship

Support transformational change to achieve institutional vision and strategies. Be an active and thoughtful participant in institutional initiatives, meetings, and committee work. Conserve resources and use in an efficient and cost effective manner across all institutional missions. Look for ways to improve and promote quality within area of influence.

Disclaimers

Background Check

Employment in this position may be contingent upon successfully completing a background and criminal history check, caregiver background check in accordance with the Wisconsin Caregiver Background Check

Law, physical examination, and / or driving record check.

Equal Opportunity Employer

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.

Diversity and Inclusion

The Medical College of Wisconsin (MCW) is committed to creating an inclusive and welcoming workplace that includes individuals with diverse backgrounds and experiences. We believe that embracing human differences is critical to realize our vision of a healthier world, and we recognize that a healthy and thriving community starts from within. We strive to integrate our human and social differences into MCW’s functioning, strategies and culture to create a diverse and equitable workplace. If you believe embracing individuality and working together makes us stronger, then MCW is the place for you. People of color, women, LGBTQIA+, veterans and persons with disabilities are encouraged to apply.

Confidentiality

Employees that have access to MCW, affiliate, subsidiary, or student data or Protected Health Information

(PI), or research protected information are obligated to protect the confidentiality and proper use and access of this information in order to prevent loss, misuse, unauthorized access, unnecessary identification, or security breaches.

Completeness

This job description is not an employment contract and the Medical College of Wisconsin may modify this document at any time. This document is intended to indicate the types of tasks and levels of skill, effort, and responsibility required by positions assigned this title. This information shall not be construed as a declaration of the specific duties and responsibilities of any particular position. It is not intended to limit or modify the right of any supervisor to assign, direct, and control the work of direct reports. The functions described are not to be interpreted as exclusive or all-inclusive of the various functions performed.

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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