Claims benefit specialist vs specialist

Differences between claims benefit specialist and specialist duties and responsibilities

Claims benefit specialist example responsibilities.

• Analyze, process and manage FMLA claims to determine eligibility and certification in compliance with state and federal regulations.
• Establish a working knowledge of CPT, ICD-9, HCPCS codes, terminology, member benefits and claim flow.
• Process claims utilizing appropriate ICD-9, DSM-IV and HCPCS codes.
• Analyze each claim and calculate percentages for both PPO and NON-PPO providers.
• Understand CPT, HCPCS, ICD-9-CM and ICD-10-CM medical claims coding regulations and guidelines
• Process Non-HMO and PPO paper and electronic claims in an accurate and time manner.
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Specialist example responsibilities.

• Create, manage, and assist users with SharePoint sites.
• Manage an on-site IRB and company good clinical practice (GCP) inspection.
• Manage SharePoint sites by creating, editing, and customizing company sites, libraries and security.
• Manage the building of accounts, assigning of static IP's, and scheduling of business class installations.
• Convert servers from UNIX to Linux, all hardware diagnostics and repair including printers/plotters/desktops etc.
• Follow safety procedures such as maintenance of all equipment (Telxon scanners, terminals and ladders).
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