Health Claims Examiner Classes and Courses

Health claims examiners, also known as health claims processors or medical claims processors, process medical insurance claims. Prospective health claims examiners can get relevant training through courses found in medical coding and billing certificate programs. Related coursework is also found in health information management or medical assisting associate degree programs.

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Essential Information

The courses found in medical coding and billing programs prepare aspiring health claims examiners for careers in many different types of medical environments, from medical and dental practices to hospitals, emergency treatment centers, clinics, assisted living facilities and insurance companies. Students who graduate from associate degree programs in health management or medical assisting are also prepared to take on office tasks beyond claims processing, such as running a front office and taking care of administrative duties. Common concepts found in these programs include:

  • Insurance and clinical procedures
  • Legal and ethical guidelines in medicine
  • Medical office administration
  • Business and medical writing
  • Pharmacology fundamentals

List of Common Courses

Introduction to Medical Terminology Course

Familiarization with medical terminology is required for aspiring health claims examiners to accurately process health insurance claims. This course introduces students to medical vocabulary and abbreviations that are commonly used in the medical industry, particularly in descriptions of diseases and medical diagnoses. It also focuses on the body's biological systems, including respiratory, digestive, reproductive, nervous and circulatory systems. This course is found in the beginning of most certificate and associate degree programs in medical billing and coding.

Managed Care and Insurance Programs Course

This course provides aspiring health claims examiners with instruction in Medicare and Medicaid benefits and insurance claim processing. It also deals with commercial healthcare systems such as health maintenance organizations (HMOs) and preferred provider organizations (PPOs). Additionally, some programs train students to register and explain health benefits to patients.

Medical Coding Course

Students must be able to understand medical diagnostic and procedural coding in order to process insurance health claims. This course provides students with instruction in the International Classification of Diseases (ICD) and the Current Procedure Terminology (CPT) coding systems. It also introduces students to the relationship between medical coding decisions and reimbursement options.

Procedures in Health Claims Processing and Examination Course

Processing health claims includes obtaining monetary reimbursement for both patients and physicians. In this course, instruction focuses on reimbursement methods, such as Ambulatory Payment Classifications (APCs). Students also receive ethics training, including instruction in health claims regulations and legal guidelines that help health claims examiners avoid claims fraud and abuse of the healthcare insurance system.

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