A medical claims specialist, also known as a health claims specialist or a medical billing specialist, is a hospital, doctor’s office, or insurance company employee. The medical claims specialist is in charge of assigning the appropriate insurance and procedural codes to bills, as well as processing insurance forms and providing patient billing services. Depending on the physician’s office or the type of billing to be processed, different levels of education are required.
A medical claims specialist may only need a high school diploma and some prior work experience in a healthcare setting, usually as an administrative assistant. He or she may then be trained as a claims specialist on the job. Some offices or healthcare organizations, on the other hand, require their claims specialists to have an associate’s degree in health information technology, as well as one of the following certifications: Certified Coding Specialist (CCS), Certified Coding Associate (CCA), or Certified Coding Specialist-Physician-based (CCSP) (CCS-P).
In this field, many community and vocational colleges offer classes or certification programs. Medical terminology is taught, as well as the billing codes needed to submit claims to insurance companies. Current Procedural Technology (CPT) and International Classification of Diseases (ICD) codes are two types of codes. In order to process claims correctly, a medical claims specialist must be familiar with and understand insurance laws.
A medical billing specialist must process payments received from patients and insurance companies, as well as apply them correctly to various accounts, in addition to filling out forms for insurance companies. Patients and insurance providers frequently have disagreements, and a medical claims specialist will likely spend much of his or her day on the phone resolving these issues, so good customer service skills and the ability to multi-task efficiently are essential. When patients call a hospital’s office or call center, medical claims specialists frequently answer questions about billing or insurance.
Medical claims specialists will need to be neat and organized, as they will be required to maintain a file system on a regular basis. They must have strong computer and data entry skills, as well as a keen eye for detail. After establishing themselves as efficient and careful workers in an office, some medical claims specialists are able to work from home. A medical claims specialist typically works regular weekday hours and earns a decent salary with benefits, making this a good choice for many people.