Billing specialist vs authorization specialist

Differences between billing specialist and authorization specialist duties and responsibilities

Billing specialist example responsibilities.

• Use of QuickBooks to manage vendors' accounts, set up filing system to maintain files and supporting billing documents.
• Manage the daily correspondence with keeping doctor/patient confidentiality under consideration along with HIPPA regulations.
• Use independent judgment, manage and impart confidential information appropriately per HIPAA regulations and company requirements.
• Accept and process healthcare claims and confidential medical records; verify patient eligibility and manage the Medicare and Medicaid billing process.
• Provide additional information/clarification for insurance claims using knowledge of CPT, ICD-9, and HCPCS codes, as well as modifiers.
• Assist staff with proper billing for patients, ensure proper coding using ICD-10, ICD-9 and CPT-4 coding.
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Authorization specialist example responsibilities.

• Demonstrate knowledge of HIPAA by appropriately managing patient confidentiality.
• Utilize CMS and InterQual criteria to establish authorizations for members requiring medical services for a Medicare advantage insurance company.
• Build authorization, match ICD-10 codes with there procedure codes
• Provide patients with patient registration forms in order to follow up on patient check-in and check-out utilizing a proprietary management system.
• Obtain verification of insurance coverage and authorizations for clinical visits and surgical procedures for patients.
• Perform all components of the office registration including arrival, check-in and future appointments.
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