A health insurance specialist is a professional hired by a healthcare facility to handle insurance claims for the medical billing process. Also called claims examiners or insurance billers, health insurance specialists ensure their organization is accurately paid for healthcare services delivered to patients. It’s their duty to keep track of medical costs, claims, adjustments, co-pays, and other billing details in electronic recordkeeping systems. The Affordable Care Act (ACA) has increased the number of insured patients demanding healthcare. Therefore, there will be more insurance claims being processed for preventative care, acute treatment, testing, and surgery. According to the Bureau of Labor Statistics, the employment of health insurance specialists will grow by 15 percent through 2024. Below is a brief job profile to help determine whether specializing in health insurance could be your forte.
What Health Insurance Specialists Do
Health insurance specialists are the primary contact between medical delivery systems and insurance carrier representatives. These professionals carefully analyze patients’ electronic health records (EHRs) to code medical treatments or diagnoses for insurance claims. They’ll carefully review claims for coding errors or mathematical mistakes and make needed changes for accuracy. Health insurance specialists will run the organization’s internal billing database to analyze payments left unpaid or deferred. Some may interact directly with patients to determine their benefits and confirm their insurance coverage. Health insurance specialists are experts at following the rules and regulations for accurately filing claims to receive timely reimbursement.
Where Health Insurance Specialists Work
Becoming a health insurance specialist unlocks doors for employment in virtually any healthcare organization delivering medical services at a cost. The highest percentage (38 percent) are employed by state, local, or private general and surgical hospitals. Physician offices are popular workplaces for health insurance specialists. Other specialists may work in nursing homes, outpatient care centers, specialty hospitals, clinics, residential care centers, drug rehabs, and mental health facilities. Some health insurance specialists are employed on the other side of healthcare for insurance companies and managed care organizations. Nearly all health insurance specialists work full-time, but their shifts may be irregular in facilities that remain open 24/7.
How to Become a Health Insurance Specialist
Working as a health insurance specialist requires you to know the latest insurance regulations and alphanumeric codes in newest ICD-10 series. Completing at least some post-secondary training is necessary. Healthcare organizations typically prefer hiring insurance specialists who obtain at least a two-year associate’s degree. Most will study medical billing, insurance claims, medical coding, or health information technology at an accredited community college. Although not required, obtaining a bachelor’s degree related to health information management could segue into administrative roles. Pursuing credentials from the Practice Management Institute to become a Certified Medical Insurance Specialist is advised. Doing so will require attending 10 live webinars and passing the CMIS exam.
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Overall, health insurance specialists assume an important role in efficiently handling all the little details involved in filing insurance claims paperwork. By reviewing patients’ EHRs, they’ll able to accurately code patient treatments and submit justified claims for compensation. Some may concentrate further in a specialty, such as cardiology, pathology, pediatrics, or neurology. Health insurance specialists enjoy a median yearly salary of $49,643, according to PayScale. For detail-oriented individuals with strong technical, analytical, and communication skills, working as a health insurance specialist can help advance as health information administrators or health services managers.
