Medical claims analyst vs worker's compensation claims examiner

Differences between medical claims analyst and worker's compensation claims examiner duties and responsibilities

Medical claims analyst example responsibilities.

• Manage cases by aggressively directing the litigation process.
• Analyze incoming medical claims using ICD-9, CPT, HCPCS coding, and Medicare fee schedules.
• Determine if claims are in compliance under patient benefit plans for payments using DRG regulations :
• Review medical records to determine if the ICD-9, CPT codes and modifiers are processed correctly.
• Adhere to the HIPAA privacy, security regulations, and maintain confidentiality of patient a business records.
• Research medical claims issues in response to informational inquiries by accessing and interpreting EOB's and claims history.
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Worker's compensation claims examiner example responsibilities.

• Manage all aspects of claims, including heavy litigation and vocational rehabilitation cases.
• Negotiate settlements and actively manage the litigation process and process complex and technically difficult claims.
• Determine benefits when processing medical claims receive as HCFA and UB92 paper claims or electronically.
• Set up vehicle inspections, and rental reservations as a part of the claim settlement process.
• Handle incoming calls from customers and providers with policy changes and claim status updates and maintain HIPAA.
• Process claim forms, adjudicates for provision of deductibles, co-pays, co-insurance maximums and provider settlements and Medicaid claims.
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