Senior claims processor vs senior claims analyst

Differences between senior claims processor and senior claims analyst duties and responsibilities

Senior claims processor example responsibilities.

• Manage confidential medical records and directs them to the appropriate practitioners while ensuring HIPPA regulations are maintain.
• Investigate, manage, negotiate and resolve claims arising out of accidents involving automobile and homeowner policies.
• Process CalPERS HMO facility claims.
• Experience with HMO's, IPA's and insurance authorizations.
• Handle confidential information according to new laws (HIPPA).
• Review ICD-9 diagnosis codes against CPT codes for claim payment guidelines.
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Senior claims analyst example responsibilities.

• Accomplish facets and Macess user including running reports.
• Manage day-to-day operations of claims department and provide general oversight and direction of all claims activity.
• Coordinate the maintenance of TPA payment type / code table conversions data.
• Process claims, generate checks, create reports and correspond with TPA clients.
• Review claims for correct billing information such as correct CPT codes, ICD code and patient information.
• Analyze, evaluate, and conduct statistical data reviews as required by CMS in accordance with ZPIC policies.
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