Claims reviewer vs call center representative

Differences between claims reviewer and call center representative duties and responsibilities

Claims reviewer example responsibilities.

• Manage day-to-day operations of claims department and provide general oversight and direction of all claims activity.
• Review worker comp claims base on state fee schedule and ICD-9 guidelines.
• Research ICD-9 codes and verify they are equivalent with customer s diagnoses.
• Review accounts per OCC guidelines that all efforts are met and due diligence complete.
• Research claims, review document findings and execute OCC approve harm test for each file.
• Help maintain company compliance with FDA and ICH Regulations/Guidelines governing the reporting of adverse event reports.
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Call center representative example responsibilities.

• Manage Facebook and patient communication programs.
• Provide member eligibility and referral status information to patients adhering to HIPAA guidelines.
• Follow all current Medicare, Medicaid and commercial insurance regulations and requirements to ensure continual compliance.
• Document all relevant information regarding patients and providers while abiding by all HIPAA and associate patient confidentially requirements.
• Navigate several screens and windows.
• Install windows, doors, cabinets, flooring.
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