Medical auditor vs release of information specialist

Differences between medical auditor and release of information 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.
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Release of information specialist example responsibilities.

• Manage and track various holds on inventory: ship on quarantine; FDA hold; and quality hold.
• Apply insurance knowledge to interpret EOB, all manage contracts and fee schedules for physician services and hospital services.
• Generate reports for managing compliance with Medicaid documentation in support of electronic billing to MCO
• Deliver customer service to patients and their families regarding access to their medical history information.
• Assist clients with choosing a Medicaid HMO.
• Handle Meditech requests then enter information into Esmartlog.
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