How do I Become a Medical Reimbursement Specialist?

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  • Written By: F. Hay
  • Edited By: A. Joseph
  • Last Modified Date: 26 February 2020
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To become a medical reimbursement specialist, you must be trained in medical billing and coding. The training period ranges from a one-year certificate program to a two-year associate’s degree in health information technology. Online courses are available, as are traditional campus college programs that will allow you to become a medical reimbursement specialist. It is important to research and choose an accredited training program that will prepare you for a certification examination. Hospital environments often require an associate's degree from a private college or community college that is accredited, such as by the Commission on Accreditation for Health Informatics and Information Management Education (CAHIIM) in the United States.

A medical reimbursement specialist assigns Current Procedural Terminology (CPT) and International Classification of Diseases (ICD) codes to bills and is responsible for processing medical bills according to payment guidelines. Medical reimbursement specialists work closely with healthcare professionals and doctors in hospitals, doctors’ offices, clinics and insurance companies to manage financial and medical records for patients. Other duties might include fraudulent claims investigation, unnecessary medical procedure review and resubmission of rejected insurance claims. If you wish to become a medical reimbursement specialist, you should be detail-oriented and organized, because the work environment often is hectic and might require multitasking.


If you are in high school and want to improve your chances for admission to become a medical reimbursement specialist in an accredited program, you might consider taking classes in health, biology, mathematics, chemistry and computer information systems. College classes teach human relations, health information technology, medical terminology, anatomy, physiology and ICD and CPT coding. Additional courses include database management, data analysis, health care reimbursement methods and clinical classification systems. In the U.S., the Certified Medical Reimbursement Specialist (CMRS) certification is available through the American Medical Billing Association. By completing an accredited training program and passing a certification examination, you will increase your changes of finding work and obtaining a higher pay rate in the healthcare industry.

Passing a certification examination provides verification of competency to become a medical reimbursement specialist and shows prospective employers your skills and your commitment to and credibility within the healthcare profession. The CMRS credential designation examination requires a passing score of 85 percent accuracy and is made up of 16 sections ranging from compliance to medical terminology. Each year after you pass the examination, you will be required to have 15 continuing education units in order to keep your CMRS credential designation renewed and current. Continuing education also might improve your chances for a management position and an increased pay rate. The need for medical reimbursement specialists has increased as more and more healthcare providers have sought certified medical reimbursement professionals who have the skills and knowledge to increase revenue, prevent fraudulent claims and keep costs down for patients and healthcare industry.


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Where can you get a Reimbursement Specialist accreditation in Ontario and/or Canada?

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