Medicare billing specialist vs certification specialist

Differences between medicare billing specialist and certification 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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Certification specialist example responsibilities.

• Support ISO audits for process documentation and software/ literature distribution, managing follow-up corrective action plans as needed.
• Pre-Certify and scheduling of MRI's and bone scans.
• Order supplies, apply cast, splints and other orthopedic equipment.
• Prepare, apply, remove and adjusts casts and splints as advised by physician.
• Review medical records to determine ICD-9 diagnosis and procedure codes according to establish guidelines and submit claims for processing.
• Assign ICD-9 codes for various clinic types such as physical, occupational and speech therapies, diagnostics and labs.
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