Certification specialist vs verification specialist

Differences between certification specialist and verification specialist duties and responsibilities

Certification specialist example responsibilities.

• Support ISO audits for process documentation and software/ literature distribution, managing follow-up corrective action plans as needed.
• Pre-Certify and scheduling of MRI's and bone scans.
• Order supplies, apply cast, splints and other orthopedic equipment.
• Prepare, apply, remove and adjusts casts and splints as advised by physician.
• Review medical records to determine ICD-9 diagnosis and procedure codes according to establish guidelines and submit claims for processing.
• Assign ICD-9 codes for various clinic types such as physical, occupational and speech therapies, diagnostics and labs.
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Verification specialist example responsibilities.

• Manage the TRICARE information program by presenting information utilizing available media, group presentations, or mailings.
• Maintain confidentiality of all patient medical information adhering to HIPPA regulations and Medicare / Medicaid policies.
• Verify primary insurance eligibility by phone with agents or online regarding Medicaid recipients and to determine payment responsibilities to providers.
• Verify medical coverage and benefits to providers and members, review certain ICD9 and CPT codes.
• Verify patient effective date of insurance, including CPT and diagnosis codes and general policy information.
• Receive extensive training on insurance plans and types, HIPAA compliance, PatientPlus programming and other workplace relate topics.
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