Medicare billing specialist vs revenue specialist

Differences between medicare billing specialist and revenue 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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Revenue specialist example responsibilities.

• Process account receivables, charge entry, claims, and reimbursement in adherence to Medicare and all HMO guidelines.
• Establish a strong understanding of ICD-9 diagnosis and medical inventory codes.
• Work claim edits to ensure clean claim billing to Medicare/Medicare HMO's.
• Review the complex medical records and accurately codes primary/secondary diagnoses and procedures using ICD-10-CM and CPT coding conventions.
• Initiate appeals and ensure required documentation are submitted in the appeals process.
• Complete appeals when authorization are not obtain and or unusual procedure are performed.
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