Medicare billing specialist vs authorization specialist

Differences between medicare billing specialist and authorization specialist duties and responsibilities

Medicare billing specialist example responsibilities.

• Accept and process healthcare claims and confidential medical records; verify patient eligibility and manage the Medicare and Medicaid billing process.
• Resolve billing issues, ensure accuracy re: CPT, HCPCS, ICD-9 codes as applicable.
• Expand knowledge with insurance EOB & Tennessee Medicare (handle denials and some occurring problems )
• Call Medicare to re-open claims due to date, CPT, units, or other changes.
• Used CPT-4 coders/Modifiers, ICD-9 codes, HCPCS codes when applicable for the resolution of claim payments.
• Comply with all HIPPA laws.
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Authorization specialist example responsibilities.

• Demonstrate knowledge of HIPAA by appropriately managing patient confidentiality.
• Utilize CMS and InterQual criteria to establish authorizations for members requiring medical services for a Medicare advantage insurance company.
• Build authorization, match ICD-10 codes with there procedure codes
• Provide patients with patient registration forms in order to follow up on patient check-in and check-out utilizing a proprietary management system.
• Obtain verification of insurance coverage and authorizations for clinical visits and surgical procedures for patients.
• Perform all components of the office registration including arrival, check-in and future appointments.
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