A reimbursement specialist collaborates with health-care providers to process and bill insurance claims, as well as collect reimbursements. On behalf of hospitals, doctors, clinics, and medical reimbursement contracting companies, these specialists interact with insurance companies and the government. Most areas require certification as a medical reimbursement specialist, which can be obtained through a regional professional board or organization.
Medical billing specialists can work for a medical billing office, an insurance company, or a medical coding and billing contractor. Community colleges and professional trade schools typically offer associate degree programs in the field. The content of certification exams to become a reimbursement specialist varies, but they typically cover billing knowledge, medical coding, basic human anatomy and medical concepts, and insurance industry terminology. Many areas allow you to take the test online, and you can usually retake it until you pass it within the time limits set the professional organization that administers the exam.
A reimbursement specialist’s typical day entails interacting with hospital or clinic staff as well as resolving claims with patients and insurance companies. As a result, specialists frequently rely on interpersonal skills and customer service abilities. Due to the sensitivity and importance of medical documents, reimbursement specialists must have a keen eye for detail and be committed to maintaining client confidentiality. Many insurance claims are initially rejected the government or an insurance company, necessitating a new approach to be resubmitted, so problem solving is an important aspect of a reimbursement specialist’s job function.
Both doctors’ offices and clinics can contract out medical coding and reimbursement to companies that specialize in the service. Smaller offices that require additional support staff or a network of doctors who use the same service providers can do so. A reimbursement specialist who works for a doctor’s office or clinic may have additional support staff responsibilities in addition to processing insurance claims.
Reimbursement specialists are in charge of reviewing insurance claims and spend time communicating with insurance companies via email and phone. A specialist may also help with paperwork and filing in a doctor’s office or clinic. The position necessitates a basic understanding of computers as well as the use of office equipment such as copiers and fax machines. To address claims, reimbursement specialists use reference materials and medical coding knowledge. They usually work regular business hours, but in large clinics, hospitals, and medical coding companies, they may be required to work around the clock shifts in order to process claims as quickly as possible.