Claim processing specialist vs billing specialist

Differences between claim processing specialist and billing specialist duties and responsibilities

Claim processing specialist example responsibilities.

• Manage expedition of appeals via problem solving and collaboration with other departments.
• Provide consumer-oriented health benefit plans, process all types of health claims knowledgeable of ICD-9 and CPT codes.
• Process medical claims for Medicaid recipients via a state-fund Medicaid insurance carrier per plan guidelines and department procedures.
• Ensure all work processes are compliant with various HIPAA regulations.
• Train on how to utilize reference materials to determine diagnosis, CPT, or appropriate HCPCS codes for claims processing.
• Provide speeches, educational information to various veterans organizations.
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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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