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Insurance Billing Specialist: Job Description, Duties and Requirements

Insurance billing specialists require little formal education. Learn about training, job duties and certification to see if this is the right career for you.

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With a certificate in medical billing or insurance coding, or an associate's degree in a related field, it is possible to begin a career as an insurance billing specialist. Insurance billing specialists process claims for health care facilities. Professional certification is also an option for those interested in a career in this field.

Essential Information

Insurance billing specialists are medical office assistants who process insurance claims for health care institutions, including hospitals, private practices and other care facilities. They must be proficient in medical terminology, health system supply procedures and insurance diagnosis codes.

Insurance billing specialist positions typically require an associate's degree or certificate. While certification from a professional organization is not mandatory, it's preferred by many employers.

Education Requirements Associate's degree or certificate in medical billing or insurance coding
Other Requirements Professional certification often required
Projected Job Outlook (2014-2024)* 15% for all medical records and health information technicians
Median Wage (2015)* $37,110 for all medical records and health information technicians

Source: *U.S. Bureau of Labor Statistics (BLS).

Job Description

Insurance billing specialists, also called coding specialists, expedite the medical billing process. They use specialized knowledge of both medicine and insurance policies to communicate with insurance companies on behalf of medical personnel and patients. Insurance companies and programs, such as Medicare and Medicaid, determine reimbursements owed to patients based on the diagnosis and health condition codes assigned by these specialists.

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Job Duties

Unlike some other medical administrative workers, coding specialists do not provide any hands-on care. They assemble and maintain patient records, review transcriptions and interact with physicians to ensure all relevant information has been recorded. Coders typically utilize the most widely accepted set of medical nomenclature, the American Medical Association's Current Procedural Terminology (CPT), to begin the billing process. Medical procedures, supplies and diseases are identified using different sets of codes.

Job Requirements

Entry-level positions often require an associate's degree or certificate in medical billing or insurance coding. In addition, some positions require insurance billing specialists to acquire and maintain certification. The American Academy of Professional Coders (AAPC) offers a number of Certified Professional Coder (CPC) designations, including credentials specific to working in hospitals and radiology cardiovascular clinics. The National Center for Competency Testing also offers an Insurance and Coding Specialist designation.

Applicants who complete a certificate or an associate's degree in medical billing or a similar field should be well-equipped to compete for job openings. Graduates may be prepared for professional certification, which may be preferred by some employers. A 15% increase in the number of jobs for all medical records and health information technicians is expected between 2014 and 2024, which is much faster growth than average when compared to all occupations.

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