What is a Health Insurance Specialist?

Health Insurance SpecialistA health insurance specialist is in charge of processing medical insurance claims with standard medical codes. They maintain electronic and paper patient records in various health care organizations. Health insurance specialists are also referred to as medical coders, claims technicians and insurance billers or specialists.

Job Description

Entry-level health insurance specialists manage, create and organize health data. They use health information systems and electronic health records software programs to maintain data integrity, quality, accuracy and security. Health insurance specialists use industry standard classification systems to code and categorize patient data for insurance billing and reimbursement purposes. Every day, they use clinical registries and databases to track patient outcomes, perform quality assessments and maintain medical files.

Senior health insurance specialists interpret and implement health care policy regarding finances, insurance and health economics. Those who work for the government analyze Medicare and Medicaid policies to identify trends among health care consumers, private organizations and health insurance companies. Some work as IT specialists to design systems that maximize research and data analysis efforts. Others work as management analysts who focus on internal operations so they can improve organizational and administrative effectiveness.

Job Requirements

Health insurance specialist must be familiar with all areas of medical billing, which includes claims, billing and payment processing. They must be fluent in medical coding and terminology. A working knowledge of data entry, databases and software programs is essential. Health insurance specialists usually work on simultaneous projects, so they must have the ability to multi-task and assign priority levels while under pressure.

Because health insurance specialists deal with sensitive and important information, they must have perfect attention to detail. For instance, medical coders and coding specialists review patient information, assign appropriate procedure codes and extrapolate demographic health statistics. A single error could result in serious billing problems and medical complications for patients.

Recommended Education

Most employers require a high school diploma and a few years of experience in the health care or health insurance fields. They also prefer health insurance specialists who have completed an education program. Most technical schools and community colleges offer medical coding or insurance technician programs.

Certificate and associate’s degree programs related to medical IT and coding typically include courses in medical anatomy, physiology and terminology. There are also classes on data, coding and classification systems. Students learn about health care statistics, billing and reimbursement methodologies. Students are encouraged to take computer science classes related to health information technology and medical science classes.

Recommended Certifications

Most employers do not health insurance specialists to obtain industry standard certification, but it will improve the job candidate’s career competitiveness. The American Academy of Professional Coders (AAPC) offers their Certified Professional Coder (CPC) certification. The basic eligibility requirements are two years of relevant work experience and medical knowledge related to areas such as anesthesia, lab tests, pathology and the body’s systems.

The American Health Information Management Association (AHIMA) offers their Registered Health Information Technician (RHIT) certification for health care professionals who specialize in electronic medical records and coding diagnoses. Exam edibility starts with an associate’s degree that is accredited by the CAHIIM.

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As an alternative, health insurance specialists with a high school diploma and at least six months of work experience may take the AHIMA’s Certified Coding Associate (CCA) certification exam.