Health Insurance Specialist Course

Please Note: This course is included in the full Medical Coding Course. This page is to illustrate what is included in that course.

The reimbursement process in medicine has become incredibly complicated. Accurately processing health insurance claims is so exacting as the plan options have expanded that it requires experts to do it right. State and federal regulations are a constant in the health care industry and continually change. This requires providers to adapt to the changes. Health Insurance Specialists are learning to fill those needs.

Those responsible for processing claims require a thorough knowledge of the insurance industry, plan options, various carrier requirements for claims, and, of course, the state and federal regulations and rules for processing.

The career of a health insurance specialist or health information specialist is challenging indeed with new opportunities arising daily. The ability to master the teaching will provide an exciting future. The Department of Labor informs that health care facilities, insurance companies, and private providers will hire claims examiners (insurance specialists) to process routine medical claims at an increased rate of 10 to 20% through the year 2010. Those with a background in the automation of the process, experience with word processing (and other computer applications, such as coding, billing software), and medical terminology proficiency will be in high demand.

The objectives in this training material are to:

  1. Provide a basic knowledge of the integral pieces of claims processing, patient information, the coding of that information, translating the codes to approved formats, and submitting them to the payer
  2. Provide information about basic insurance plans, private and government
  3. Provide information about legislation and the laws impacting providers
  4. Provide information on how to manage inappropriately paid claims
  5. Teach preparation of the variables for the CMS-1500 claim form

The job market includes:

  1. Claims benefit advisors in health, malpractice and liability insurance companies
  2. Coding or insurance specialists in government settings, legal offices, billing companies, medical societies and associations
  3. Educators/trainers for agencies, providers
  4. Consultants providing assistance to practices (coding, billing, insurance processing, claims appeals procedures, practice management)
  5. Consumer (patient) advocates who assist private individuals in ascertaining the claims payment process, intervention with payers and providers
  6. Management/supervisory status in provider offices

Basic skill requirements:

  1. Medical terminology including anatomy, physiology, and ability to interpret and abstract a medical report
  2. Diagnosis and procedure coding
  3. Billing processes and financial reporting analysis
  4. Good reading and comprehension skills
  5. Basic understanding of mathematics (adding, subtracting, calculating percentages)
  6. Communication skills
  7. Detail-oriented
  8. Interpreting the law as it relates to medicine and integrate into practice profiles and methodologies
  9. Interpreting regulations, rules from various payers
  10. Implementation of compliance issues, mandates
  11. Data entry skills with good accuracy

With a commitment to understand fully and complete the training, you will have made a large and fundamental career move that could lead to broader horizons.