Adjustment examiner vs medical claims analyst

Differences between adjustment examiner and medical claims analyst duties and responsibilities

Adjustment examiner example responsibilities.

• Manage Kemper's internal loss control and claims for all Kemper employees and offices.
• Blood collection by venipuncture and capillary technique ensure all specimens are collect accurately, on time and according to establish procedures.
• Coordinate vendor referrals for additional investigation and/or litigation management

Medical claims analyst example responsibilities.

• Manage cases by aggressively directing the litigation process.
• Analyze incoming medical claims using ICD-9, CPT, HCPCS coding, and Medicare fee schedules.
• Determine if claims are in compliance under patient benefit plans for payments using DRG regulations :
• Review medical records to determine if the ICD-9, CPT codes and modifiers are processed correctly.
• Adhere to the HIPAA privacy, security regulations, and maintain confidentiality of patient a business records.
• Research medical claims issues in response to informational inquiries by accessing and interpreting EOB's and claims history.
Show more