Reinsurance claims analyst vs medical claims examiner

Differences between reinsurance claims analyst and medical claims examiner duties and responsibilities

Reinsurance claims analyst example responsibilities.

• Help managed meetings regarding decision making on CMS regulations.
• Conduct quarterly internal commutations SOX testing.
• Ensure the privacy and security of protect health information per HIPPA requirements
• Confirm general ledger shows all accounting transactions for given period and reconciliations are conduct.
• Request and review documentation and testing in order to qualify patients for Medicare and Medicaid coverage.
• Analyze office administration support for analysts supporting DOD projects to identify efficiency opportunities to prototype and write report of analysis findings.
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Medical claims examiner example responsibilities.

• Manage cases by aggressively directing the litigation process.
• Process medical facility claims payment according to account-specific contract (HMO, PPO, EPO, etc . )
• Process PPO, HMO, comprehensive plans, including medicare supplements, hospital, chiropractic and physical therapy claims.
• Identify which claims are eligible for PPO reprising.
• Resolve medical claims by approving and/or denying base on CMS guidelines for Medicaid/Medicare claim processing.
• Verify that all ICD-9, CPT, modifiers and revenue codes are used correctly, prior to payment approval.
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