Medical collections specialist vs billing representative

Differences between medical collections specialist and billing representative duties and responsibilities

Medical collections specialist example responsibilities.

• Manage accounts for healthcare clients, review detailed patient information for payment resolution while abiding HIPPA privacy and security regulations.
• Job duties include collecting on HMO, PPO, Medicare, and HMO Medicaid.
• Work directly with Medicare and HMO Medicaid plans, and statewide HMO/PPO/POS plans.
• Reprocess denied medical claims using extensive appeal tactics or special appeals processing instructions for commercial and government carriers.
• Adhere to all HIPAA guidelines as well as various policies and guidelines.
• Provide itemized billing statements and screen HIPAA authorization forms for hundreds of legal firms.
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Billing representative example responsibilities.

• Manage software programs for MSP accounts, monthly billing and EMC file transfers to Medicare.
• Accept and process healthcare claims and confidential medical records; verify patient eligibility and manage the Medicare and Medicaid billing process.
• Process orders in compliance with Medicare, Medicaid and private insurance verification guidelines; confirming customer's eligibility and insurance coverage.
• Verify insurance eligibility for schedule appointments, and verify cash pricing for private pay patients who request cost by CPT code.
• Submit and receive Medicare and Medicaid claims electronically on a daily basis.
• Utilize extensive computer skills and coding knowledge to produce and submit physical therapy and occupational therapy claims through medicaid and medicare.
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