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What Does a Reimbursement Specialist Do?

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  • Written By: L.K. Blackburn
  • Edited By: Allegra J. Lingo
  • Last Modified Date: 12 March 2014
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A reimbursement specialist works with health-care professionals to process and bill out insurance claims and customer payments, and also collect reimbursements. These specialists interact with insurance companies and the government on behalf of hospitals, doctors, clinics, and medical reimbursement contracting companies. Certification as a medical reimbursement specialist is generally required in most areas, and can be obtained through a regional professional board or organization.

Specialists may be employed at a medical billing office, work for an insurance company, or work at a medical coding and billing contractor. Associate degree programs in the field are typically available at community colleges and professional trade schools. The certification tests to obtain accreditation as a reimbursement specialist vary in content, but generally include material on billing knowledge, medical coding, relevant basic human anatomy and medical concepts, and insurance industry terminology. Many areas allows the test to be taken online, and it often can be retaken until passed, within set time frames established by the professional organization that administers the exam.

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A typical day for a reimbursement specialist includes interaction with hospital or clinic staff and working with patients and insurance companies to resolve claims. As a result, people skills and customer service abilities are often utilized by specialists. The sensitivity and importance of medical documents means that reimbursement specialists need to possess a strong attention to detail and responsibility for client confidentiality. Problem solving is also 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 require a new approach to be resubmitted.

Medical coding and reimbursement can also be contracted out by both doctors' offices and clinics to companies who specialize in the activity. This may be done by smaller offices who need additional support staff, or by a network of doctors who share the same service providers. When working for a doctor's office or clinic, a reimbursement specialist may have additional support staff responsibilities beyond processing insurance claims.

Reimbursement specialists are in charge of reviewing insurance claims, and spend time emailing and talking on the phone with insurance companies. Paperwork and filing within a doctor's office or clinic is often also undertaken by a specialist. The job requires basic knowledge of computers and the use of office equipment such as copiers and a fax machine. Reimbursement specialists utilize reference materials and medical coding knowledge to address claims. They generally work typical business hours, but the work may be done in around-the-clock shifts in large clinics, hospitals, and medical coding companies to employ more staff to process claims as quickly as possible.

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