Medical reimbursement specialist vs medical coder

Differences between medical reimbursement specialist and medical coder 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.
Show more

Medical coder example responsibilities.

• Manage all EDI relate communication with trading partners and assist to produce all operational documents for all end users.
• Manage all aspects of AR including writing letters for medical necessity, claim denials, bundling issues and charge capture.
• Manage health records while applying ICD-10 coding to update and process insurance claims for time and accuracy to various insurance companies.
• Manage the outsourced transcription company.
• Create documentation education classes to general surgery residents, increasing the leveling of reporting which lead to increase revenues.
• Adhere to regulations with CPT-4, ICD-9-CM and HCPCS coding with medical terminology and effort meet all audit requirements.
Show more