Claims adjudicator vs reinsurance claims analyst

Differences between claims adjudicator and reinsurance claims analyst 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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Reinsurance claims analyst example responsibilities.

• Help managed meetings regarding decision making on CMS regulations.
• Conduct quarterly internal commutations SOX testing.
• Ensure the privacy and security of protect health information per HIPPA requirements
• Confirm general ledger shows all accounting transactions for given period and reconciliations are conduct.
• Request and review documentation and testing in order to qualify patients for Medicare and Medicaid coverage.
• Analyze office administration support for analysts supporting DOD projects to identify efficiency opportunities to prototype and write report of analysis findings.
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