Medical Insurance Specialist PDF Print E-mail
Written by David Andrews   
Thursday, 04 November 2010 15:54
Health InsuranceHealthcare facilities and providers employ "medical insurance specialists" to submit claims, respond to inquiries from medical insurers, and to follow up on overdue payments. The financial stability of the healthcare provider is tied to a steady, dependable flow of payments from medical insurance companies and the government for services provided to subscribers. There are many medical insurers each having their own procedures for receiving, approving, and paying claims.

Medical insurance specialists must know claims processing and billing regulations, and needs to know how to code bills based on the procedures the healthcare provider performed on the patient. The medical insurance specialists must also know how to re-appeal claims which medical insurer partially pay or claims that are rejected by a medical insurance company. Medical insurers usually try to rope in medical expenses and in doing so create extra work for healthcare providers such as requiring preauthorization by the medical insurer before he healthcare provider performs certain procedures on the patient. Post-treatment reports must be submitted to the medical insurer following the procedure. The medical insurance specialist is typically the person responsible for getting the preauthorization and preparing and submitting post-treatment reports.

Medical Insurance Specialists specialize in one or more of the following areas:

Coding specialists: Prepares claims for healthcare providers to submit to medical insurance companies.
Consultant: Providing billing and claim services to healthcare providers.
Claims benefit advisor: Provides expert advice to healthcare providers, malpractice lawyers, and liability insurance companies.
Education: Training medical insurance specialists.
Editor: Writing about health insurance.
Consumer Claims Assistant: Files claims and appeals for low reimbursement on behalf of patients.
Private Billing: Files claims for elderly and disabled patients.

Qualifications for Medical Insurance Specialists:

A Medical Insurance Specialist Must

• Have good understanding of medical terminology.
• Be ethical.
• Have knowledge of conventions and rules used in diagnoses and procedural coding.
• Have basic Knowledge of anatomy and physiology.
• Have good oral and written communication skills.
• Have critical reading and comprehension skills.
• Have basic computer skills needed to access data electronically.
• Have basic math skills.
• Be detailed, oriented.
Last Updated on Monday, 08 November 2010 11:59

ICD-10 Corner

9 benefits of ICD-10

1. Measuring the quality, safety and efficacy of care
2. Designing payment systems and processing claims for reimbursement
3. Conducting research, epidemiological studies, and clinical trials
4. Setting health policy
5. Operational and strategic planning and designing healthcare delivery systems
6. Monitoring resource utilization
7. Improving clinical, financial, and administrative performance
8. Preventing and detecting healthcare fraud and abuse
9. Tracking public concerns and assessing risks of adverse public health events

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