What is a Medical Reimbursement Specialist?

In a hospital or doctor’s office, a medical reimbursement specialist is responsible for a variety of important administrative tasks. He or she is in charge of maintaining accurate records of patient information and making sure that bills are paid on time. In addition, specialists code patient diagnoses and send formal payment requests to insurance companies. They work with patients to set up payment plans for large bills. The nature of the job necessitates that professionals be extremely detail-oriented, organized, and productive.

Working in a health-care setting can be stressful. Doctors and nurses are always on the move, visiting patients and entering data into medical charts. A medical reimbursement specialist gathers data from practitioners’ charts and records and enters it into a computer-based filing system.

A medical reimbursement specialist’s main responsibility is to convert patient data into a standard coding format. To accurately log medical records and submit easy-to-understand reports to insurance companies, coding patient forms is essential. The majority of professionals have been trained to code data using the Current Procedural Terminology® (CPT®) or International Classification of Diseases (ICD) standards. Following the coding of bills, specialists check them for accuracy, save the documents, and send copies to insurance companies.

A medical reimbursement specialist must have excellent communication skills. On a daily basis, a professional interacts with patients, insurance company representatives, and doctors. Before patients leave the office, he or she frequently speaks with them in person to collect co-payments and set up payment plans. If a doctor’s patient report is unclear, the specialist should ask them to clarify points so that accurate records can be kept. If there is a question about a particular bill, insurance representatives contact the specialist phone or email.

In most countries, getting into the field requires at least an associate’s degree in medical coding or health information technology. Many community colleges, universities, and specialized technical schools offer degrees, which typically take two years to complete. Medical terminology, coding CPT® and ICD forms, human relations, and computer science are common courses taken students.

An individual can take a certification exam administered a respected national organization after completing an associate’s degree program to improve their chances of finding work. In the United States, organizations like the American Health Information Management Association provide new professionals with the credentials they need to work in hospitals, clinics, psychiatric wards, and private doctor’s offices. A medical reimbursement specialist who gains experience and continues their education may be able to advance to the position of manager.