Claims coordinator vs insurance assistant

Differences between claims coordinator and insurance assistant duties and responsibilities

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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Insurance assistant example responsibilities.

• Cold-Cal to generate leads for individual life and disability insurance and annuities.
• Analyze Medicaid models, Medicare and HIPAA transaction documents.
• Assign ICD-9 and CPT codes to office visit and inpatient and outpatient procedures.
• Process electronic claims, pre-existing and subrogation investigation, point of service, and PPO and HMO processing.
• Train staff on billing software in regards to CPT codes and pricing, submission procedures, and industry regulations.
• Perform verification of Medicare and Medicaid coverage and limits.
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