Ten Qualifications a Medical Insurance Specialist Must Have

Medical insurance specialists must communicate with insurance companies, patients and others.
i Keith Brofsky/Photodisc/Getty Images
Medical insurance specialists must communicate with insurance companies, patients and others.

Responsible for procuring all forms of reimbursement, medical insurance specialists are crucial to the success of physicians' practices, hospitals and other health care organizations. According to the Bureau of Labor Statistics, growth for jobs in medical records and health information such as billing professionals is much faster than average. If you are considering a career in this field, learning what it takes can point you in the right direction.

Current Certification

Most medical employers seek to hire insurance specialists who have received certification through an accredited organization. For instance, passing the Certified Medical Reimbursement Specialist or Certified Billing and Coding Specialist exam displays knowledge and skills in the industry equal to the national standard.

Comprehension of Insurance Types and Terminology

Because there are so many different types of health care coverage and numerous terms to explain what is and is not covered, a medical insurance specialist must be familiar with and have a clear understanding of these differences and definitions to bill insurance companies and patients properly.

Knowledge of Health Insurance Laws and Regulations

Medical insurance specialists need to have some knowledge of state and federal laws regarding coverage, standards and reimbursements to ensure compliance with the Office of Inspector General, understand coverage under the Consolidated Omnibus Reconciliation Act of 1985 (COBRA) and prevent health insurance fraud or abuse.

Understanding of Medical Coding

When a health care provider treats a patient, the medical insurance specialist must assign the appropriate code to ensure the correct reimbursement amount from the patient's health insurance provider. As of October 2014, the International Statistical Classification of Diseases standard is ICD-10, which increases the number of codes from about 13,600 established in 1977 to more than 144,000.

Familiarity with Medical Terminology

As insurance specialists must be able to code, bill, file and investigate procedures and services properly, it is important for them to understand the terms doctors and other providers use on charts and in conversations. In addition, they may need to refer to these terms when communicating with patients and health insurance companies.

Familiarity with Medicare and Medicaid

Medicare, the federal social insurance program, and Medicaid, a state-based coverage program for low income consumers, have specific rules and regulations regarding network coverage, covered services and reimbursement procedures. Knowledge of these guidelines can help ensure prompt reimbursement and prevent unintentional fraud.

Training in Billing and Collection Procedures

Creating properly coded bills and sending invoices to health insurance providers or patients is only one step in the billing and collection process. Medical insurance specialists should be able to make patients aware of co-pays, deductibles and other out-of-pocket costs prior to appointments. In addition, they may be required to follow up with payers regarding past due reimbursements.

Awareness of HIPPA Privacy Practices

The Health Insurance Portability and Accountability Act addresses health coverage retention and confidentiality regarding protected health information. A medical insurance specialist must know basic regulations and possess the ability to find detailed information on the law to protect patients and avoid security breaches.

Customer Service Skills

Insurance specialists frequently communicate with patients, health insurance providers and others regarding billing questions, overdue payments and other sensitive information. Having the ability to listen patiently and communicate effectively while remaining calm and focused will help resolve issues quickly and without issue.

Conflict Management Proficiency

Even with excellent customer service skills and understanding of policies and procedures, not all conversations and interactions will go smoothly. A medical insurance specialist who knows how to prevent and resolve stressful, destructive conflicts is likely to improve outcomes.

2016 Salary Information for Medical Records and Health Information Technicians

Medical records and health information technicians earned a median annual salary of $38,040 in 2016, according to the U.S. Bureau of Labor Statistics. On the low end, medical records and health information technicians earned a 25th percentile salary of $29,940, meaning 75 percent earned more than this amount. The 75th percentile salary is $49,770, meaning 25 percent earn more. In 2016, 206,300 people were employed in the U.S. as medical records and health information technicians.

the nest