Insurance Reimbursement Specialist Job Description

Insurance Reimbursement Specialists are primarily responsible for working with insurance companies and medical billing staff to manage the billing/reimbursement process. These professionals specialize in tasks related to ensuring that physicians and other medical professionals are paid appropriately for their services.

Insurance Reimbursement Specialist: Job Responsibilities

In order to manage the billing/reimbursement process, Insurance Reimbursement Specialists are typically responsible for the following tasks:

• Identifying methods of payment for patients
• Correlating insurance coverage with services to be provided
• Managing financial and medical records
• Medical coding
• Review records, coding and billing practices to ensure compliance
• Preparation and review of insurance claims
• Submit insurance claims to insurance carriers
• Follow up on unpaid claims
• Invoice preparation

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Common Employment Settings for Insurance Reimbursement Specialists

Insurance Reimbursement Specialists work in a wide variety of employment settings throughout the medical and insurance industries. Among the most common of these are:

• State, Local and private acute-care hospitals
• Physicians' offices
• Companies that provide administrative and support services to medical professionals and health care facilities
• Nursing homes
• Skilled nursing facilities
• Rehabilitation hospitals
• Insurance companies
• Medical software firms
• Medical/insurance consulting firms

Insurance Reimbursement Specialists: Career Outlook

The Bureau of Labor Statistics (BLS) Occupational Outlook Handbook does not provide information specifically for Insurance Reimbursement Specialist positions. Rather, they group these administrative professionals in the Medical Records and Health Information Technicians category. According to BLS, workers in this category can expect to see employment rate growth of 13 percent from 2016 to 2026, which is faster than the average job growth rate for all occupations.

The agency attributes this faster than average job growth rate to a wide range of factors. Among the most important of these, is the aging of the U.S. population, which is expected to lead to an increased demand for medical services. This is expected to increase demand for Insurance Reimbursement Specialists and other healthcare administrative and information professionals.

Organizing and management of health information, billing, coding data and insurance claims are among the duties to be in high demand. Additionally, BLS also predicts increased demand for these professionals as usage of health care information technologies, like electronic health records (EHRs) become more widespread.

It is important to note that while this information can offer readers a general idea of the career potential of various occupations, job market data from the US Bureau of Labor Statistics Occupational Handbook is intended to provide insight on occupational opportunities. That data is not to be construed as a guarantee of salary or job title. Neither BLS nor Bryant & Stratton College can guarantee employment in this or any other occupational field.

What can I do with a Medical Reimbursement and Coding Associate Diploma?

The first step to becoming an Insurance Reimbursement Specialist is earning a degree. Bryant & Stratton’s Medical Reimbursement and Coding diploma is a great option. This degree program offers students a well-rounded education in medical reimbursement and coding, providing them with the skills they need to perform the essential functions necessary to excel in this field. They will learn how to carry out medical coding, billing, and record keeping. They will gain understanding of medical terminology, body systems and structures, and common drugs and treatments.

The skills learned by completing the Medical Reimbursement and Coding associate degree program will equip for a successful career as an Insurance Reimbursement Specialist and many other positions in the administrative realm of health care. Navigating the industry-specific terms and parameters requires specialized training. As the industry evolves and changes, a specialist may be required to participate in continuing education, when necessary.

This associate degree program is designed to meet standards set by the American Health Information Management Association (AHIMA).

Additional Training/Requirements to Become an Insurance Reimbursement Specialist

To be hired as an Insurance Reimbursement Specialist, many employers will require that you hold certain professional certifications. Earning professional certifications generally means meeting certain educational and work experience standards set by the certifying organization and passing an exam administered by that organization.

Many employers, especially in health care environments, will require that Insurance Reimbursement Specialists undergo background checks and, in many cases, drug screening tests. In many areas, these screenings are required by state health care regulations for any employee who works in a clinical setting, like hospitals, nursing homes or medical practices. Often, employers will require that newly hired Insurance Reimbursement specialists undergo a period of on the job training as a condition of continued employment. Typically, this training is designed to ensure that employees are well-versed in the policies, procedures and practices of their specific employment setting.

For more insights into preparing for a career as an Insurance Reimbursement Specialist or in the health care field in general, please visit the health care degree section of the Bryant and Stratton College blog. There, we provide resources and insights you need to begin planning and building a satisfying and successful career.