Skills Needed to Become an Insurance Billing Specialist

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The Insurance Billing Specialist is a individual who has been trained in the field or specialty of processing medical insurance clams. The Insurance Billing Specialist is known by many other names, including Medical Insurance Specialist, Medical biller/coder, Patient Account Representative and a Medical Administrative Assistant.

Billing Specialist play a vital role in the financial success of a medical practice, because 85% to 90% of a practice's income is generated from third-party reimbursements. Well trained Insurance Billing Specialist can recoup lossed income for a practice who has had incorrectly billed reimbursements, therefore, companies welcome expert Billers.

The main responsibility of an insurance biller involves collecting reimbursements for services rendered by hospitals, clinics, medical practices, and other healthcare agencies. Some positions require the billing specialist to perform bookkeeping tasks that include posting data and keeping records concerning invoices and support documents. The insurance specialist needs the ability to resolve discrepancies in accounting records.

There are two types of billing, facility billing this type is performed in hospitals, skilled nursing or long term care facilities, rehabilitation centers, and /or ambulatory surgical centers. The second type of billing is professional billing is performed for physicians and /or non physician practitioners, such as nurse practitioners (NPs), clinical nurse specialists (CNSs), and physician assistants (PA).

The skills needed to perform daily responsibilities include the ability to use a keyboard, and the ability to operate adding, calculating, and billing machines to compute fees and payments due. Although communication skills are important in every job, medical insurance specialists usually don't have as much direct contact with patients as do their clinical counterparts.

The detailed descriptions of the duties of a medical insurance specialist include the following:

  • Reviewing itemized charges, bills, or personal data forms for accuracy and/or completeness and making the necessary corrections.
  • Completing insurance claim forms based on the data that are provided on itemized bills, claim worksheets or hospital admissions records, which requires identifying and interpreting the information to be coded and recorded on the claim forms.
  • Correcting or editing insurance claim forms based on verbal or written communication with third-party payers.
  • Reviewing payment records and posting or adjusting records as required Making inquiries of and responding to a variety of questions from physicians, patients, insurance companies, government representatives, and related interested parties.
  • Credentials most often required are the completion of an approved vocational or technical school program. On-the-job experience or an associate's degree can also be considered as qualifications.

Graduates of an insurance billing specialist program can expect many opportunities, as careers in health care are among the fastest growing occupations that exist today. Insurance billing specialists and medical coders also benefit from the type of career that lends itself well to home-based businesses.

Be prudent, do your homework, make a full investigation of all the necessary requirements, pros and cons, before you decide if the career of Insurance Billing is for you.

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Comments 3 comments

Claudia Marie profile image

Claudia Marie 4 years ago Author

Thank you for your comment and the helpful web site.


alocsin profile image

alocsin 3 years ago from Orange County, CA

I think one can also get certified for this job, right? Certification should increase job prospects. Voting this Up and Interesting.


Claudia Marie profile image

Claudia Marie 3 years ago Author

Yes, you can get a billing certification. Thanks for your comment.

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