Health claims examiner vs medical claims processor

Differences between health claims examiner and medical claims processor 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

Medical claims processor example responsibilities.

• Enter UB 92 and 1500 HCFA medical claims into computer system manage and process insurance claims.
• Manage cases by aggressively directing the litigation process.
• Submit medical claims to commercial insurance companies, Medicare, and Medicaid for payment with use of ICD-9 and CPT coding.
• Review and verify patient account information against insurance program specifications, analyze surgical procedures and diagnoses using CPT-4 and ICD-9 codes.
• Acknowledge and enforces confidentiality in alignment with (HIPPA) guidelines.
• Audit encounters and ICD-10 codes to ensure correct coding and maximum reimbursement.
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