Chapter 1 The Insurance Billing Specialist

Careers in Health Care

Insurance Billing Specialist An insurance billing specialist: –Processes claims in accordance with appropriate regulations –Works closely with financial and managerial areas of health care –Is a key player in the financial operation of a medical office

Qualifications Personal –Adaptable –Detail-oriented –Ethical –Honest –Maintains confidentiality –Self-motivated Technical –Data entry –Documents messages –Math skills –Oral and written communication skills –Ability to follow directions

Qualifications Medical terminology –Ability to read and understand medical reports –Recognize diagnostic statements and treatments –Identify discrepancies in documentation Medical coding protocols: keep current! –ICD –CPT

Reinforcement Exercise What are the personal and/or technical qualifications described below? 1.Anita tells her supervisor that she used the wrong insurance code on the claims she sent out yesterday. 2.Martha loaded patient insurance files into the financial database.

Employment Opportunities Opportunities range from entry level to management Many places available to work, from offices to government agencies to consulting firms Insurance billing specialists are also called billing clerk, medical biller, insurance claims processor, and reimbursement specialist

Employment Opportunities Claims assistance professional Insurance collection specialist Patient account representative Insurance counselor Medical coder

Job Responsibilities Common tasks to all billing positions: –Abstract information from patient records –Communicate via fax, , telephone, letters, memos –Understand legal and ethical issues –Follow office policies and procedures –Maintain professionalism –Participate in continuing education

Job Responsibilities Claims assistance professionals –Work directly with clients Insurance collection specialists –Work for medium to large health care agencies Patient account representatives –Work to establish payment options before services are provided

Certification American Association of Medical Billers (AAMB) Medical Association of Billers (MAB) American Medical Billing Association (AMBA) Professional credential exams are viewed as objective measures of an individual’s expertise in a field

Certification American Health Information Association (AHIMA) American Academy of Professional Coders (AAPC)