What does a Medical Insurance Specialist do?

Medical insurance specialists handle a variety of important tasks in and around doctors’ offices and other medical facilities. A typical medical insurance specialist will collaborate closely with patients, insurance companies, and other office staff to ensure that all charges, claims, and payments are processed quickly. The specialist is usually knowledgeable about local health plans, how to read and prepare medical bills, and how to calculate the proper health care costs associated with any procedure performed. Here are a few examples of the types of tasks that this type of specialist is likely to perform on a daily basis.

One of the most important responsibilities of a medical insurance specialist is to collect and evaluate the insurance coverage that patients currently have. It is possible to determine if any co-pays are due at the time services are rendered or if the insurance provider will cover all costs going over the coverage with patients. This critical task ensures that no time is wasted filing claims that will not benefit the patient or the health-care provider, and that everyone is aware of when and how payment will be made.

In addition to reviewing charges and submitting claims to insurance companies, the medical insurance specialist is involved in the review of claims. The specialist also works with billing personnel to ensure that invoices for services rendered are complete and billed at the correct rates as part of this process. The information can then be used to prepare and submit insurance claims on behalf of the patient to the insurance company. When the claim is properly completed, the insurance company can respond quickly, either rejecting the claim or paying the health care provider.

A working knowledge of medical coding is not uncommon among medical insurance specialists. Most insurance companies use universal coding to categorize and evaluate submitted claims. Knowing how to properly code claims helps to speed up the processing and, as a result, allows the health care facility to be compensated more quickly.

The medical insurance specialist’s job also entails keeping accurate and up-to-date information in each patient’s medical records. This ensures that data is available to support any claims made to insurance companies, as well as providing a platform to track any correspondence received from them. This level of detail is required in many jurisdictions as a matter of basic standards for health care providers and as a means of complying with local laws.

A qualified medical insurance specialist can work in a variety of health-care settings. The specialist may work in clinics, hospitals, and nursing homes in addition to a doctor’s office. This type of job can also be found in public health agencies and private healthcare organizations. A medical insurance specialist is likely to be required in any situation where there is a need to understand health insurance plans and the various types of insurance issues that can arise.