Health claims examiner vs claims benefit specialist

Differences between health claims examiner and claims benefit specialist duties and responsibilities

Health claims examiner example responsibilities.

• Manage claims, route/queues, and ECHS, within specify turn- around time parameters.
• Review and analyze medical claims to finalize payments according to Medicaid benefits.
• Analyze and process Medicare and Medicaid claims (Primary/Secondary).
• Blood collection by venipuncture and capillary technique ensure all specimens are collect accurately, on time and according to establish procedures.
• Coordinate vendor referrals for additional investigation and/or litigation management

Claims benefit specialist example responsibilities.

• Analyze, process and manage FMLA claims to determine eligibility and certification in compliance with state and federal regulations.
• Establish a working knowledge of CPT, ICD-9, HCPCS codes, terminology, member benefits and claim flow.
• Process claims utilizing appropriate ICD-9, DSM-IV and HCPCS codes.
• Analyze each claim and calculate percentages for both PPO and NON-PPO providers.
• Understand CPT, HCPCS, ICD-9-CM and ICD-10-CM medical claims coding regulations and guidelines
• Process Non-HMO and PPO paper and electronic claims in an accurate and time manner.
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