Senior claims examiner vs medical claims examiner

Differences between senior claims examiner and medical claims examiner duties and responsibilities

Senior claims examiner example responsibilities.

• Manage day-to-day operations of claims department and provide general oversight and direction of all claims activity.
• Coordinate vendor referrals for additional investigation and/or litigation management
• Maintain office records of various types of complaints, conciliation, administrative decision, private litigation resolution, gather detailed information.
• Ensure all HIPPA regulations are followed in the creation and release of all confidential records.
• Coordinate vendor referrals for additional investigation and/or litigation management

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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