Medical claims specialist vs medical records clerk

Differences between medical claims specialist and medical records clerk 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 records clerk example responsibilities.

• Manage transition from in-house transcription system to outsource transcription service.
• Manage front office check-in, insurance verification and certifications from doctors.
• Accept and process healthcare claims and confidential medical records; verify patient eligibility and manage the Medicare and Medicaid billing process.
• Perform infant labs and update the system with results, triage incoming patients, perform necessary resuscitation to baby and mom.
• Provide information to medical facilities and patients when necessary and respond to subpoenas and other general release of patient information.
• Experience in CPT and ICD-10 coding.
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