Hospital insurance representative vs quality specialist

Differences between hospital insurance representative and quality specialist duties and responsibilities

Hospital insurance representative example responsibilities.

• Cold-Cal to generate leads for individual life and disability insurance and annuities.
• Verify that each CPT code are paid correctly and according to fee schedule for any overpayment or underpayment ..
• Provide financial counseling for patients and their families by explaining financial policies and providing available resources for alternative payment.
• Fill out refund form with copy of all relate EOB's when credit balances are find on account.
• Serve as a resource/ advocate to all employees regarding claims problem resolution, benefits explanations and EOB issues.
• Collect patient demographic & insurance information via telephone for outpatient surgery and radiology.

Quality specialist example responsibilities.

• Manage CMOs that provide Endo with API, bulk, packaging services, and/or finish goods, including clinical material.
• Manage PPAP sample dimensional verification activities.
• Recommend changes to organizational committee structure to achieve higher level of accountability and oversight.
• Manage document control including initiating and revising procedures, QA approval and implementation of documents.
• Manage performance improvement and quality improvement projects design to assess and improve health outcomes for Medicaid members.
• Manage hospital core measures abstraction, registry abstractions and review services to assist healthcare organizations in improving performance.
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