Medicare specialist vs revenue specialist

Differences between medicare specialist and revenue 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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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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