Referral specialist vs insurance verification specialist

Differences between referral specialist and insurance verification specialist duties and responsibilities

Referral specialist example responsibilities.

• Manage assignments of paying medical bills limit in depth that include organizing and researching regulations as pertain to veterans eligibility.
• Interview patients, evaluate eligibility, collect co-pays, deductibles, including, but not limit to insurance verification.
• Input HIPAA information, call physician offices to verify testing, collect copay's and deductibles.
• Arrange for debt repayments or establish repayment schedules and send out insurance claims with the correct ICD-9 and CPT codes.
• Research referrals and either deny or approve based on information obtain and appropriately identify diagnosis (CPT and ICD-9 coding).
• Maintain confidentiality by following all applicable HIPAA regulations.
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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.
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