Medical Reimbursement Specialist Job Description

Reimbursement Specialist: A Professional Network for Medical Records and Health Information Technology

Reimbursement specialists are responsible for managing the financial activities of patient payers from the time products or services are rendered until the payment cycle ends. Reimbursement specialists are used to manage claims processing, such as overseeing disputed, delayed or rejected claims. They need to be decisive and personable as they interact with patients, state, federal and private representatives, fiscal intermediaries, pharmacy partners and managed care case managers.

Reimbursement specialists with communication skills are experts at reaching the proper personnel in every party, explaining problems with claims and configuring payment schedules. They are knowledgeable about claims processing. Employers prefer candidates with an understanding of coding and medical terminology.

Reimbursement specialists excel in a number of areas. They have basic computer skills, including database monitoring. Specialists handle many clerical tasks.

They are in charge of reporting reimbursement trends and issues to managed care organizations and departments, as well as notifying business services divisions of implementations on renewals or new contracts. Reimbursement specialists work with payers to fix reimbursement problems. They keep up with outstanding claims until the final payment is made.

Reimbursement specialists communicate with patients, families, doctors and office personnel to answer questions about coverage on certain procedures. They keep a database to monitor underpayment occurrences. Specialists report to management about any changes that will affect their company.

Reimbursement Specialist

Specialists can work at medical billing offices, medical coding and billing contractors, or work for an insurance company. Community colleges and professional trade schools offer associate degree programs in the field. The certification tests for accreditation as a reimbursement specialist vary in content, but generally include material on billing knowledge, medical coding, and insurance industry terminology.

The test can be taken online and can be re-taken if the professional organization that administers the exam gives them enough time. A typical day for a reimbursement specialist includes working with patients and insurance companies to resolve claims. People skills and customer service abilities are often used by specialists.

Reimbursement specialists need to have a strong attention to detail and responsibility for client confidentiality because of the sensitivity of medical documents. Problem solving is an important aspect of a reimbursement specialist's job function, as many insurance claims may be rejected initially by the government or an insurance company and need a new approach to be resubmitted. Reimbursement specialists are in charge of reviewing insurance claims and talking to insurance companies.

A doctor's office or clinic can be filled with paperwork and filing by a specialist. Basic knowledge of computers and office equipment is required for the job. References and medical coding knowledge are used by reimbursement specialists.

Reimbursement Specialist Position

You don't need a college education to work as a reimbursement specialist if you have the right amount of insurance industry knowledge. Many employers look for candidates with a high school degree. Many employers look for candidates with several years of experience in the insurance industry.

If you have done clerical work, you could still be considered for a reimbursement specialist position. Reimbursement specialists must process claims quickly and accurately, and make sure there are no errors or issues in the claim. They may have to do some administrative work, update patients' medical files and make sure other members of the medical staff are aware of the changes.

Reimbursement specialist positions do higher level work such as investigating claims issues and making recommendations to management for process improvements. Reimbursement specialists must have good communication skills to monitor and audit accounts. They must be able to deal with customer inquiries on their own.