Medicare specialist vs authorization specialist

Differences between medicare specialist and authorization specialist duties and responsibilities

Medicare specialist example responsibilities.

• Manage cases by aggressively directing the litigation process.
• Submit correct claims when appropriate, assigning ICD-9-CM, CPT, HCPCS, and / or service codes when necessary.
• Maintain HIPPA compliance with all communications.
• Obtain accurate ICD-9 codes and process completed CMN's.
• Include knowledge of ICD-9 codes and state fee schedules/usual and customary.
• Code claims using the CPT and ICD-9-CM coding systems appropriate at the time.
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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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