Medical auditor vs medical biller coder

Differences between medical auditor and medical biller coder duties and responsibilities

Medical auditor example responsibilities.

• Review confidential and substantial health documentation and make sound, evidence-base decisions concerning compliance to HIPPA and other manage care policies.
• Handle and interpret medical documentation such as UB04 claim forms and EOB's on a daily basis.
• Review all EOB's to ensure claim paid per contract and submit appeals for claims underpay or deny payment in error.
• Review medical records to determine if clinical documentation support coding and DRG assignments.
• Advance knowledge - CMS and provider contract rules.
• Process HCFA and UB claims in a production environment.
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Medical biller coder example responsibilities.

• Manage chart completion (ICD-9-CM and CPT coding), chart assembly and analysis and patient information privacy/security.
• Use EMR software to manage patient records and files reinforce and uphold patient confidentiality as required by HIPAA and clinic.
• Manage chart completion (ICD-9-CM and CPT coding/abstracting), chart assembly and analysis, patient admission and patient information privacy/security.
• Bill insurance claims using HCFA 1500 and UB-92 form.
• Review coding, verify the diagnosis codes (ICD-9) and procedure codes (CPT) are congruent and clinically appropriate.
• Have experience in all commercial insurances and government insurances including Medicare and Medicaid.
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