Medical claims specialist vs medical collector

Differences between medical claims specialist and medical collector 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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Medical collector example responsibilities.

• Use EMR software to manage patient records and files; reinforce and uphold patient confidentiality as required by HIPAA and clinic.
• Perform as a mediator between insurance companies and patients collecting nationwide extensive medical bills.
• Utilize A/R reports and identify accounts that are past payments.
• Maintain a filing system of clients' medical records and disclosure following HIPPA guidelines.
• Post appropriate adjustment types and carrier payments to accounts for true A/R account balance reflection.
• Maintain strict confidentiality; adhering to all HIPAA guidelines/regulations.
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