Claims adjudicator vs claims vice president

Differences between claims adjudicator and claims vice president duties and responsibilities

Claims adjudicator example responsibilities.

• Manage appeals and authorizations by examining information and performing necessary adjustments.
• Handle claims processing utilizing knowledge of medical coding standards, including HCPCS, CPT, and ICD-9.
• Calculate refunds or credit balances involving reprocessing for partial adjustments and correct the CPT and ICD-9 codes.
• Maintain compliance with HIPAA guidelines and regulations
• Adjudicate claims for Medicaid, Medicare, and ambulance billing.
• Interpret and processes routine and complex claims per Medicaid industry standards.
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Claims vice president example responsibilities.

• Retain and manage outside counsel; develop and coordinate strategy for litigation; participate in alternative dispute resolution and negotiate settlements.
• Provide management oversight of client support at offices in Indiana, Kentucky and Ohio.
• Provide vision, oversight and direction to claims and encounter processing and claims systems configuration.
• Work with underwriting carrier to ensure that all TPA responsibilities are being handle according to the TPA guidelines.
• Establish and direct internal and external performance standards and procedures for use with TPA's or general agents.
• Negotiate claims litigation, including settling lawsuits via mediation strategies.
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