Verification specialist vs revenue specialist

Differences between verification specialist and revenue specialist duties and responsibilities

Verification specialist example responsibilities.

• Manage the TRICARE information program by presenting information utilizing available media, group presentations, or mailings.
• Maintain confidentiality of all patient medical information adhering to HIPPA regulations and Medicare / Medicaid policies.
• Verify primary insurance eligibility by phone with agents or online regarding Medicaid recipients and to determine payment responsibilities to providers.
• Verify medical coverage and benefits to providers and members, review certain ICD9 and CPT codes.
• Verify patient effective date of insurance, including CPT and diagnosis codes and general policy information.
• Receive extensive training on insurance plans and types, HIPAA compliance, PatientPlus programming and other workplace relate topics.
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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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