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Account Rep II - Anthem id-7225

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 as 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 registration and update corresponding Department 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 Account Rep I.
  • Perform necessary billing activities such as claims to maintain team goals or assist other teams.
  • Works special projects as assigned by supervisor.

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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.

Education:High School DiplomaEmployment Type: Full Time

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