Claims resolution specialist vs solution specialist

Differences between claims resolution specialist and solution 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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Solution specialist example responsibilities.

• Lead multiple team meetings covering best practices, new policy and procedures, and explaining new MBO targets.
• Manage existing accounts while identifying new sources of opportunities for sales in the SME segment through cold calling and prospecting.
• Manage payroll and overall candidate compliance regarding eligibility of employment and new hire paperwork.
• Manage billing inquiries, encourage cross-selling and referral for additional property and casualty lines of business.
• Manage Microsoft SQL consolidation project to improve the operational efficiency of database servers and reduce their licensing costs.
• Research and implement new technology solutions including a CRM software, email marketing opportunities, and a company blog.
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