Medicare specialist vs insurance verification specialist

Differences between medicare specialist and insurance verification 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.
Show more

Insurance verification specialist example responsibilities.

• Check CPT and ICD-10 codes with LCD and policies from multiple insurance companies to make sure procedures will be paid.
• Support the patient privacy/confidentiality policies and regulations under HIPAA for patients and their medical records.
• Confirm correct charges base on HCPCS codes.
• Assist callers as well with questions about their benefits, terms and conditions of medical plans, appeals and grievances.
• Provide medical record support in the absence of EMR: assist clinics and hospitals in obtaining medical records in appropriate format.
• Document outbound communication from providers and veterans.
Show more