Medical claims specialist vs billing specialist

Differences between medical claims specialist and billing specialist duties and responsibilities

Medical claims specialist example responsibilities.

• Apply Medicare, Medicaid billing guidelines to achieve maximum reimbursement.
• Detail knowledge of medical coding; ICD-9, CPT and HCPCS codes.
• Confirm coverage and work with private payers, commercial payers, Medicaid, and Medicare for reimbursement of provide medical services.
• Research medical records, compliance requirements and explanations of benefits to resolve accounts payable for Medicare, Medicaid and commercial insurance.
• Maintain strict confidentiality/privacy of patients' protect health information in accordance with HIPAA regulations.
• Assist in educating new hires in HIPPA laws and training.
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Billing specialist example responsibilities.

• Use of QuickBooks to manage vendors' accounts, set up filing system to maintain files and supporting billing documents.
• Manage the daily correspondence with keeping doctor/patient confidentiality under consideration along with HIPPA regulations.
• Use independent judgment, manage and impart confidential information appropriately per HIPAA regulations and company requirements.
• Accept and process healthcare claims and confidential medical records; verify patient eligibility and manage the Medicare and Medicaid billing process.
• Provide additional information/clarification for insurance claims using knowledge of CPT, ICD-9, and HCPCS codes, as well as modifiers.
• Assist staff with proper billing for patients, ensure proper coding using ICD-10, ICD-9 and CPT-4 coding.
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