Claim specialist vs claim processing specialist

Differences between claim specialist and claim processing specialist duties and responsibilities

Claim specialist example responsibilities.

• Assist in the streamlining of EDI process to manage workflow of EDI claims.
• Manage claims on desk, route/queues, and ECHS within specify turn-around-time parameters.
• Manage claims, route/queues, and ECHS, within specify turn- around time parameters.
• Investigate, manage, negotiate and resolve claims arising out of accidents involving automobile and homeowner policies.
• Upgrade CPT-4 and ICD-9 coding procedures, staying in step with many manage care plans changing reimbursement schedules.
• Manage expedition of appeals via problem solving and collaboration with other departments.
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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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