Medical auditor vs reimbursement specialist

Differences between medical auditor and reimbursement specialist 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.
Show more

Reimbursement specialist example responsibilities.

• Manage the EDI clearinghouse rejections.
• Process department payroll, order supplies, and manage petty-cash funds.
• Manage use of various systems, such as MEDITECH, Cerner, WebNow, and yield-base follow-up tool.
• Manage cases by aggressively directing the litigation process.
• Negotiate fee structure for manage care contracts on acute and rehabilitation facilities.
• Research medical coding ICD-9, ICD-10, HCPCS and CPT-4 to let client know the outcome of medical claim.
Show more