Medical Claims And Billing Specialist

Medical Claims And Billing Specialist Career Facts

A medical claims and billing specialist manages records and files insurance claims. The specialist prepares insurance forms and handles billing. A medical billing and coding specialist works for clinics, doctor's offices, hospitals or private billing services.

A medical claims and billing specialist has expertise in these areas:

•         Medical Law and Ethics
•         Methods of Reimbursement
•         Medical Terminology
•         Anatomy and Physiology
•         Medical Information Management
•         Medical Office Practice

Many specialists have the Certified Coding Specialist credential from the AHIMA (American Health Information Management Association) Several specialists are Certified Professional Coder by the American Academy of Professional Coders.

Job Description

These are some responsibilities of a medical billing and claims specialist:

•         Process medical claims
•         Handle patient invoices
•         Obtain reimbursements for both patients and doctors.
•         Recognize terms for human anatomy and disorders
•         Recognize diagnoses and treatments
•         Enter diagnosis and procedure codes
•         Follow standard billing guidelines for surgical procedures
•         Submit claim forms for private insurance organizations
•         Comply with federal regulations

The specialist collates all information regarding the patient's health.  He makes sure that the patients' medical charts are complete.  He checks all completed forms to see if they are properly authenticated.

All information is recorded into a computer. Computer skills are essential. Coders work with different computer programs. These are updated regularly. The specialist must pay special attention to details of treatments, insurance claims and laws.

The specialist helps consumers thoroughly understand their health information. They make sure health care providers give patients the appropriate care. This way, the medical claims and billing specialist plays a key role in the health care team.

Each time a patient receives medical attention, the medical coding specialist codes, bills, and processes the medical case. Clerical, organizational and people skills are important. High school mathematics, health, biology, typing, bookkeeping, computers and office skills are excellent  preparation for the job.

So a medical claims and billing specialist must be proficient in financial analysis.  They must also be experts in workflow, software, insurance claims submission and management.


Areas of interest to the medical billing specialist are:

•         Patient and electronic medical records (EMR) management
•         HIPAA compliance
•         Health insurance rules
•         Insurance fraud issues

Those entering this field should consider medical coding and billing training. The program must be approved by the US Department of Education. This could be in a vocational school. There are medical billing and coding online or distance education courses.


Today, medicine and technology are rapidly advancing. Opportunities for medical billers and coders abound. It can be challenging breaking into this field.  But a medical claims and billing specialist career can be very rewarding.

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