Claims resolution specialist vs customer care specialist

Differences between claims resolution specialist and customer care 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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Customer care specialist example responsibilities.

• Continue to manage a high volume of customer calls relate to HMO, PPO and POS concerns.
• Provide unbias assistance to Medicaid providers with questions regarding Medicaid patient eligibility, medical claims statuses and other program questions.
• Present PowerPoint presentations in a webinar format that introduce new features and enhancements to self- service, e-commerce portal.
• Authenticate callers before providing personal health information to avoid breaking HIPAA guidelines.
• Verify then analyze and troubleshoot customer's questions regarding student loan disbursement procedures and banking accounts.
• Maintain working knowledge of numerous product lines as well as policies to effectively troubleshoot and/or replace defective products
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