Claims resolution specialist vs billing specialist

Differences between claims resolution specialist and billing specialist duties and responsibilities

Claims resolution specialist example responsibilities.

• Manage expedition of appeals via problem solving and collaboration with other departments.
• Assist provider with ICD-9, CPT and revenue codes, DME, coordination of benefits, efficiently train on HIPPA.
• Process medical claims submit to Kansas Medicaid using establish guidelines and policies.
• Ensure compliance with HIPAA regulations and requirements.
• Determine the types of claims using submit diagnoses, CPT, and HCPS codes.
• Communicate with claimants and insure individuals alike while ensuring privacy and HIPPA laws are maintain.
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Billing specialist example responsibilities.

• Use of QuickBooks to manage vendors' accounts, set up filing system to maintain files and supporting billing documents.
• Manage the daily correspondence with keeping doctor/patient confidentiality under consideration along with HIPPA regulations.
• Use independent judgment, manage and impart confidential information appropriately per HIPAA regulations and company requirements.
• Accept and process healthcare claims and confidential medical records; verify patient eligibility and manage the Medicare and Medicaid billing process.
• Provide additional information/clarification for insurance claims using knowledge of CPT, ICD-9, and HCPCS codes, as well as modifiers.
• Assist staff with proper billing for patients, ensure proper coding using ICD-10, ICD-9 and CPT-4 coding.
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