Insurance billing specialists often work in office settings.
Insurance billing specialists play an important role in the insurance world. As those responsible for preparing, submitting or processing medical claims, billing specialists work for insurance companies and in doctors' offices, hospitals, nursing facilities, home health care agencies and medical labs, among other settings. The five most important skills needed for the role are: insurance industry knowledge, data entry skills, coding skills and experience, superior attention to detail and problem-solving skills.
Insurance Industry Knowledge
Most employers require insurance billing specialists to have health insurance industry knowledge. Understanding the basic concepts of health insurance payments, such as co-insurance, deductibles and maximums, helps when handling claims. The billing specialist also needs to understand the difference between in and out-of-network providers and how this applies to billing and claims. The billing specialist must understand the claims submission process, including how claims are submitted and how they are paid. This knowledge will help in recognizing errors and maintaining a smooth submission process. Lastly, many employers prefer employees with knowledge of state and federal billing regulations.
Data Entry Skills
Though parts of the billing and claims process may be automated, some of it includes manual data entry. The employee must be skillful in data entry, including speed and accuracy of typing. Employers may require the employee to meet a minimum word-per-minute typing score. Accuracy is extremely important in billing as transposing numbers or inputting a number incorrectly can have a major impact on payments. Additionally, the employee needs familiarity with word processing and billing systems and claims software. The job requires multitasking, speed and superior time management skills.
Coding Skills
As an insurance billing specialist, you need knowledge of procedure and diagnosis codes. Most employers will require thorough experience working with CPT and ICD-9 coding. Providers submit billing and claims using these codes, and the insurer pays based on the codes. To comprehend the codes, you will need a working knowledge of medical terminology. Some billing specialists specialize in one type of coding, depending on the employer. For instance, a billing specialist in a psychiatrist's office or working for a behavioral health care insurer may have the most frequent mental health codes memorized.
Problem-Solving Skills and Attention to Detail
Billing specialists typically maintain close attention to detail. The ability to recognize billing errors is a preferred skill. In addition, this position requires excellent problem-solving skills and the ability to resolve issues and errors early. When billing issues escalate, the specialist may need to research an issue issue, obtain additional information, work toward a solution and ensure proper documentation of the claims. Insurance billing specialists follow up on submissions of paper and electronic claims, and may adjust, resubmit or reprocess claims.
Tags: billing specialists, billing claims, billing specialist, claims billing, attention detail, billing specialists
