Claims adjudicator vs health claims examiner

Differences between claims adjudicator and health claims examiner 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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Health claims examiner example responsibilities.

• Manage claims, route/queues, and ECHS, within specify turn- around time parameters.
• Review and analyze medical claims to finalize payments according to Medicaid benefits.
• Analyze and process Medicare and Medicaid claims (Primary/Secondary).
• Blood collection by venipuncture and capillary technique ensure all specimens are collect accurately, on time and according to establish procedures.
• Coordinate vendor referrals for additional investigation and/or litigation management