Claim processing specialist vs resolution specialist

Differences between claim processing specialist and resolution 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.
Show more

Resolution specialist example responsibilities.

• Used software tools including: microsoft excel, powerpoint, outlook.
• Provide members with accurate and appropriate information to answer questions, troubleshoot issues, and resolve member complaints.
• Respond to service inquiries regarding existing deposit accounts, ATM and debit cards, consumer loans and eCommerce applications.
• Contribute written materials and course content for exercises to NADL training and content to PowerPoint presentations as subject matter expert.
• Analyze, troubleshoot, and resolve complex software, hardware, and networking issues for small and large business owners.
• Contact federal (Medicare, TRICARE), state (Medicaid), and private health insurance companies for lien information.
Show more