Claims director vs health claims examiner

Differences between claims director and health claims examiner duties and responsibilities

Claims director example responsibilities.

• Create project team that comply with new Medicare reporting requirements achieving successful reporting to CMS.
• Maintain relationships with attorneys and manage litigation strategy; ensure strong relationships with insureds, brokers and third party administrators.
• Redesign processes and procedures for managing litigation through the implementation of an aggressive process for managing discovery and case typing.
• General knowledge of CPT, ICD-9, HCPCS, DRG and Medicode (UCR), bundling and unbundling.
• File and respond to online arbitration matters.
• Facilitate annual updates to all new and revise CPT codes assuring accurate claims payment.
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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