Claims vice president vs medical claims analyst

Differences between claims vice president and medical claims analyst duties and responsibilities

Claims vice president example responsibilities.

• Retain and manage outside counsel; develop and coordinate strategy for litigation; participate in alternative dispute resolution and negotiate settlements.
• Provide management oversight of client support at offices in Indiana, Kentucky and Ohio.
• Provide vision, oversight and direction to claims and encounter processing and claims systems configuration.
• Work with underwriting carrier to ensure that all TPA responsibilities are being handle according to the TPA guidelines.
• Establish and direct internal and external performance standards and procedures for use with TPA's or general agents.
• Negotiate claims litigation, including settling lawsuits via mediation strategies.
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Medical claims analyst example responsibilities.

• Manage cases by aggressively directing the litigation process.
• Analyze incoming medical claims using ICD-9, CPT, HCPCS coding, and Medicare fee schedules.
• Determine if claims are in compliance under patient benefit plans for payments using DRG regulations :
• Review medical records to determine if the ICD-9, CPT codes and modifiers are processed correctly.
• Adhere to the HIPAA privacy, security regulations, and maintain confidentiality of patient a business records.
• Research medical claims issues in response to informational inquiries by accessing and interpreting EOB's and claims history.
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