Medical billing supervisor vs credentialing specialist

Differences between medical billing supervisor and credentialing specialist duties and responsibilities

Medical billing supervisor example responsibilities.

• Accept and process healthcare claims and confidential medical records; verify patient eligibility and manage the Medicare and Medicaid billing process.
• Verify CPT, ICD-9 and HCPCS codes bill according to government regulation and guidelines.
• Monitor and make notes of trends find in reviewing physicians ICD-9 and CPT coding according to CMS guidelines.
• Resolve discrepancies leveraging extensive experience going through appropriate procedures to facilitate medical claims review, fee schedule pricing and appeals process.
• Conduct ICD-10 training for coding staff and auditing team.
• Full knowledge and practice of HIPPA and patient confidentiality policy and procedures.
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Credentialing specialist example responsibilities.

• Establish rapport with all PCP offices, hospital personnel, and manage care representatives.
• Manage and administer the programs CME accredit education programs/Conferences.
• Ensure enrollment and participation with all organization contract managed care plans and perform Medicaid/Medicare provider enrollment.
• Process and manage all requests and applications for CME certification and supervise activities relate to credentialing process.
• Perform spot claims audits to ensure CMS compliance with ICD-9, HCPCS, CPT, and other requirements.
• Maintain and track data for OPPE and FPPE according to hospital policy and regulatory requirements.
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