Medical Reimbursement Specialist
The Medical Reimbursement is a growing field in healthcare. Healthcare Reimbursement Specialists are critical to healthcare providers, facilities and organizations, as they have direct impact on revenue. Hospitals and healthcare providers report coded data to third-party payers to receive payment for services. The Healthcare Reimbursement Specialist uses coding techniques to process all insurance and billing forms to ensure proper and complete payment.
The Healthcare Reimbursement Specialist’s primary function is to ensure that patients' insurance covers the treatments and services being billed. They update and manage the portfolio of all patient accounts, process billing, and submit invoices to insurance companies and other payers. They review payer documentation to ensure payments and bills for co-pays are accurate – as well as check coding information to ensure the care provided corresponds to the charges submitted. Other responsibilities include identifying and correcting billing inaccuracies, documentation, performing transfers, collections, tracking patterns of non-payment, documenting insurance benefit changes, and coordinating with service offices.
When there are issues, the Healthcare Reimbursement Specialist contacts payers directly to resolve underpayments and denials. They identify fraudulent non-plan billing practices and may assisting the legal department with litigation preparation. At all times, they must protect the integrity and confidentiality of patient and company files.
The Associate degree program in Healthcare Reimbursement teaches basic outpatient coding, Medicare and Medicaid practices, insurance terminology, and billing and reimbursement skills. Core courses include Fundamentals of Medical Office Protocol Medical Terminology, Insurance Reimbursement & Billing Procedures, Office Procedures, Computerized Billing & Practice Management, and Coding Procedures.
Students also get specialized training in Current Procedural Terminology (CPT), International Classification of Diseases (ICD), and Health Care Financing Administration Common Procedural Coding System (HCPCS). Students also participate in a supervised externship to learn the billing and coding process.
Qualifications for positions include proficiency in Microsoft Office, excellent interpersonal skills, and superior customer service skills. Those pursuing careers in this field must have the personal skills to interact effectively with service offices, clients, and payers. Strong attention to detail, persistence, patience, creativity, and a self-motivated work style are all necessary attributes for a successful career in healthcare reimbursement.
by Linda Bright
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