Health Claims Specialist: Job Description and Requirements for Becoming a Health Claims Specialist
Health claims specialists process medical insurance claims and resolve billing issues. They often work for insurance companies, health care providers and hospitals. Many employers require a high school diploma and experience in the health care or insurance industries, but some might need more advanced education.
Health Claims Specialist Job Description
Health claims specialists gather and process information needed to complete medical insurance claims. They do much of their work on the telephone, taking inbound customer-service calls and making outbound calls to patients and health care providers. In addition to processing routine claims, they investigate pending claims and resolve discrepancies. They can work in call centers of health maintenance organizations (HMOs) as well as insurance companies, physician's offices and hospital billing departments.
Health Claims Specialist Requirements
Entry-level jobs in health claims generally require a high school diploma, but employers could prefer applicants with an education in health information technology or medical billing. Some vocational schools and community colleges offer certificate programs specifically for health claims specialists, with coursework in medical terminology, transcription, billing and coding. Employers might also favor applicants who have experience in medical billing, previous employment in the insurance industry or professional certification.
Professional certification in coding or medical information technology might increase a health claims specialist's chances of finding employment or advancing in his or her career. The American Health Information Management Association (AHIMA) offers various credentials in this area, including several insurance coding certifications and the Registered Health Information Technician (RHIT) credential (www.ahima.org). A candidate must earn an associate's degree from a program accredited by the Commission on Accreditation for Health Informatics and Information Management Education to qualify for the RHIT certification exam.
Health claims specialists must have good customer-service, data-entry, word-processing and phone skills. They also need a working knowledge of claims-payment laws as well as medical terminology. Additionally, these specialists must be familiar with diagnostic coding systems and coding procedures.
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