Insurance specialist vs revenue specialist

Differences between insurance specialist and revenue specialist duties and responsibilities

Insurance specialist example responsibilities.

• Manage database by processing renewals and endorsements.
• Maintain confidentiality and adhere HIPPA guidelines with handling patients' information
• Make recommendations on operationalization and oversight of specific marketplace enrollment policies.
• Verify various health insurance plan benefit information and eligibility for patients with chronic illnesses.
• Identify third party patient eligibility for Medicaid, Medicare, private insurance and alternate resources.
• Enter and prepare advanced beneficiary notices base on diagnosis and procedure codes for Medicare cover patients.
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Revenue specialist example responsibilities.

• Process account receivables, charge entry, claims, and reimbursement in adherence to Medicare and all HMO guidelines.
• Establish a strong understanding of ICD-9 diagnosis and medical inventory codes.
• Work claim edits to ensure clean claim billing to Medicare/Medicare HMO's.
• Review the complex medical records and accurately codes primary/secondary diagnoses and procedures using ICD-10-CM and CPT coding conventions.
• Initiate appeals and ensure required documentation are submitted in the appeals process.
• Complete appeals when authorization are not obtain and or unusual procedure are performed.
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