Billing specialist vs revenue specialist

Differences between billing specialist and revenue 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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Revenue specialist example responsibilities.

• Process account receivables, charge entry, claims, and reimbursement in adherence to Medicare and all HMO guidelines.
• Establish a strong understanding of ICD-9 diagnosis and medical inventory codes.
• Work claim edits to ensure clean claim billing to Medicare/Medicare HMO's.
• Review the complex medical records and accurately codes primary/secondary diagnoses and procedures using ICD-10-CM and CPT coding conventions.
• Initiate appeals and ensure required documentation are submitted in the appeals process.
• Complete appeals when authorization are not obtain and or unusual procedure are performed.
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