Medical auditor vs medical records clerk

Differences between medical auditor and medical records clerk 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 records clerk example responsibilities.

• Manage transition from in-house transcription system to outsource transcription service.
• Manage front office check-in, insurance verification and certifications from doctors.
• Accept and process healthcare claims and confidential medical records; verify patient eligibility and manage the Medicare and Medicaid billing process.
• Perform infant labs and update the system with results, triage incoming patients, perform necessary resuscitation to baby and mom.
• Provide information to medical facilities and patients when necessary and respond to subpoenas and other general release of patient information.
• Experience in CPT and ICD-10 coding.
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