Medical Insurance Specialist Job Description

A medical insurance specialist typically works directly for a medical provider.

A medical insurance specialist typically works directly for a medical provider.

Navigating through the medical insurance process can be enough to give anyone a headache. Thanks to medical insurance specialists, patients and medical providers receive assistance in dealing with the endless stream of medical codes, reimbursement processes and billing issues. According to the Bureau of Labor Statistics (BLS), as of 2012 women make up 89 percent of all medical insurance specialists, also known as medical record techs or health information specialists.

What it Takes

While you won’t need a special degree to work as a medical insurance specialist, you will need at least an associate's degree in any field. Some employers will also accept a high school diploma or a certificate degree program. Most likely, you’ll also receive some on-the-job training to learn the particular computer programs and systems employers use, as well as becoming familiar with all the different insurance codes. Not required by every employer, certification as a medical insurance specialist gives you a leg up in the industry. Certification comes from industry groups like the Practice Management Institute and generally requires meeting certain experience requirements and passing an exam.

Skills You’ll Need

You’ll need more than just an education and professional experience; medical insurance specialists must also possess certain skills. Because of the huge amount of data and information you’ll come into contact with every day, you must be well-organized and have a keen eye for details. Other helpful skills for medical insurance specialists include being discreet when dealing with personal and private information, and having excellent customer service skills to handle patient inquiries and issues. Along with basic computer programs like Microsoft Office, you should be familiar with insurance software programs such as Cerner ProFit or Revenue Manager.

Day-to-Day Duties

As a medical insurance specialist, your main duty is processing insurance claims and assuring that an insurance company reimburses the medical practice for all services. You also work directly with patients, reviewing their accounts and helping them find solutions, whether it be through insurance, payment plans or other payment assistance, for paying for whatever health care services they received from that facility. Other daily duties include answering patient questions regarding their insurance coverage, keeping detailed electronic patient insurance records and interpreting medical codes to bill insurance companies.

Other Responsibilities

If you’re employed by a small office or practice, you may wear other hats besides medical insurance specialist. Other responsibilities include managing accounts payable, accounts receivable and the payroll. Some medical insurance specialists process patient referrals to specialists and assist the patient in finding a specialist based on what their insurance will cover. Many medical insurance specialists assist patients in obtaining authorization from their insurance companies for specific procedures and treatment. Additionally, they keep an eye out for any signs of insurance fraud, and send notices to patients with overdue bills.

 

About the Author

Lindsey Thompson began her writing career in 2001. Her work has been published in the Cincinnati Art Museum's "Member Magazine" and "The Ohio Journalist." Thompson holds a Bachelor of Science in journalism from the Scripps School of Journalism at Ohio University.

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