Medical reimbursement specialist vs medical claims processor

Differences between medical reimbursement specialist and medical claims processor duties and responsibilities

Medical reimbursement specialist example responsibilities.

• Accept and process healthcare claims and confidential medical records; verify patient eligibility and manage the Medicare and Medicaid billing process.
• Review and submit medical documentation for medical claims appeals as necessary.
• Review and assign ICD-9, CPT-4 and HCPCS, and correct E/M codes to each patient encounter to prevent recovery credits.
• Verify private medical insurance benefits and Medicaid eligibility.
• Follow up on unpaid/unresolve account balances, including claims reject electronically and EOB denials.
• Research account activity base on analysis reports and correspondence resulting in additional follow-up with patients, insurance carriers and referring physicians.
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Medical claims processor example responsibilities.

• Enter UB 92 and 1500 HCFA medical claims into computer system manage and process insurance claims.
• Manage cases by aggressively directing the litigation process.
• Submit medical claims to commercial insurance companies, Medicare, and Medicaid for payment with use of ICD-9 and CPT coding.
• Review and verify patient account information against insurance program specifications, analyze surgical procedures and diagnoses using CPT-4 and ICD-9 codes.
• Acknowledge and enforces confidentiality in alignment with (HIPPA) guidelines.
• Audit encounters and ICD-10 codes to ensure correct coding and maximum reimbursement.
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