A reimbursement specialist processes and bills insurance claims, interacts with insurance companies and the government, and collects reimbursements. Certification is required, and specialists may work in medical billing offices, insurance companies, or medical billing and coding companies. They need people skills, attention to detail, and troubleshooting abilities. They may also have additional support staff responsibilities. Basic computer skills are required, and they use reference materials and medical coding expertise. They usually work typical business hours, but may work non-stop shifts at large clinics, hospitals, and medical coding companies.
A reimbursement specialist works with healthcare professionals to process and bill client insurance claims and payments, as well as collect reimbursements. These specialists interact with insurance companies and the government on behalf of hospitals, doctors, clinics and medical reimbursement contracting companies. Generally, certification as a medical reimbursement specialist is required in most areas and can be obtained through a regional professional council or organization.
Specialists may be employed in a medical billing office, work for an insurance company, or work for a medical billing and coding company. Field degree programs are usually available at community colleges and professional schools. The certification tests for certification as a reimbursement specialist vary in content, but generally include material on knowledge of billing, medical coding, relevant basic human anatomy and medical concepts, and insurance industry terminology. Many areas allow the test to be taken online, and it can often be repeated until passed, within deadlines set by the professional organization administering the exam.
A typical day for a claims specialist includes interacting with hospital or clinic staff and working with patients and insurance companies to resolve claims. As a result, people skills and customer service are often used by specialists. The sensitivity and importance of medical documents means that reimbursement specialists need to have a strong attention to detail and responsibility for client confidentiality. Troubleshooting is also an important aspect of a claims specialist’s role, as many insurance claims may be rejected initially by the government or an insurance company and require a new claim to be resubmitted.
Medical coding and reimbursement can also be contracted by doctors’ offices and clinics to companies specializing in the activity. This can be done by smaller practices that need additional support staff or by a network of physicians who share the same providers. When working in a physician’s office or clinic, a reimbursement specialist may have additional support staff responsibilities in addition to processing insurance claims.
Reimbursement specialists are responsible for reviewing insurance claims and spend time emailing and talking on the phone with insurance companies. Paperwork and filing within a doctor’s office or clinic is also usually handled by a specialist. The job requires basic computer skills and the use of office equipment such as copiers and fax machines. Reimbursement specialists use reference materials and medical coding expertise to handle claims. They usually work typical business hours, but the work can be done in non-stop shifts at large clinics, hospitals and medical coding companies to employ more staff to process claims as quickly as possible.
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