Claims account specialist vs claims coordinator

Differences between claims account specialist and claims coordinator duties and responsibilities

Claims account specialist example responsibilities.

• Manage accounts for healthcare clients, review detailed patient information for payment resolution while abiding HIPPA privacy and security regulations.
• Interview incoming patients, his/her relatives, or other responsible individuals to obtain identifying and biographical information with insurance and financial information
• Review HMO insurance vouchers and resubmitted if necessary.
• Utilize excellent communication and negotiation skills to resolve credit card delinquency favorable to company and card member.

Claims coordinator example responsibilities.

• Investigate, evaluate, and manage call to complete coverage analysis confirming or denying coverage using Xactimate estimating software.
• Process and adjust Medicare claims, provide feedback to providers on proper CPT, ICD-9 coding for billing purposes.
• Serve as point of contact for all legal issues relate to HIPAA.
• Streamline audit procedures of TPA and maintain extremely high production rate which help in keeping staffing requirements lower.
• Review and audit claims -Using correct CPT and DX codes -Denial reports -correct billing error, resubmitted claims for proper payment
• Communicate with company management, injure workers/customers, medical providers and TPA, as necessary, regarding claim relate matters.
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