Health Insurance Specialist Career Profile


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In the field of healthcare, there may be many different professionals involved in caring for patients and managing the financial and health-related paperwork associated with this care.

The connection between these many different professionals can help to ensure that patients are receiving the right quality of care and the healthcare facility is receiving adequate payment for the services rendered. In this current day and age, payments outstanding within healthcare organizations may be at an all-time high.

This could be due to the hold-up caused by insurance agencies awaiting additional information regarding treatment or the inability of patients to make ample payment on their hospital bills.

The insurance-related aspect of payments outstanding can potentially be resolved by the addition of educated and experienced health insurance specialists. These professionals may be the primary source of information when working with insurance agents to receive payment for services provided to insured clients.

Click to search for online health administration programs that are currently taking applications.

What do Health Insurance Specialists do?

Hospitals and other healthcare agencies may employ these professionals to assist with being paid promptly for services, so that a hospital can reduce the amount of outstanding charges currently owed to their facility.

Health insurance specialists may work alongside medical coders and claims processors to assist during the claim process with insurance companies. On a regular basis, these professionals may have to ensure that procedures are coded in accordance to insurance guidelines, as well as ensure that patient files are accurate in terms of the types of treatment they have received.

This type of front work can help to make the payment process move smoother, which can result in quicker payment for the healthcare organization. Health insurance specialists may also be responsible for overseeing a staff of employees responsible for turning medical claims into insurance agencies.

How do I become a Health Insurance Specialist?

Many entry-level positions in health insurance billing and coding may only require a high school education or certificate program to achieve. However, if you are interested in becoming a health insurance specialist, you should invest more into your education in order to experience the benefits of being an expert in this aspect of healthcare.

Most professionals at this level have achieved a minimum of a bachelor’s degree focusing on insurance, healthcare or healthcare administration. These degree programs can help you become more familiar with the healthcare billing process so that you can promote better efficiency within your field.

Achieving a college degree is a great first step in moving forward into this career field. Some healthcare facilities look for professionals that have gone the extra mile and obtained a relevant degree, as well as those that have experience within the field.

The amount of work experience required to be considered a health insurance specialist might be different depending on the person you ask. In general, most healthcare organizations ask for applicants to have 3-5 years of professionals experience in healthcare or insurance in order to be considered for these positions.

If you are curious as to where you can obtain relevant work experience for this career field, you might begin your search within medical billing and coding. This type of career can help familiarize you with the codes used by hospitals and healthcare agencies for specific diagnoses and treatments provided by their facility.

Other professionals starting in the insurance field can also be accustomed to using this lingo in their field. Once you have obtained work experience alongside a related degree, you should seek out careers within your area.

Health Insurance Specialist Programs to Consider

If you are part of the large group of people considering healthcare-related degree programs, you may be pleased to learn that they can be found at several universities all over the country. Health insurance specialists may choose bachelor’s or master’s programs for their education, since different employers may have different requirements for their professionals. One of the most popular degree programs for upcoming professionals in health insurance may be the online Bachelor’s in Healthcare Administration.

This degree program can provide ample information regarding the healthcare process, finance and billing that may be required for specialists in this field. Our team of educational experts has reviewed some of the most popular online programs throughout the country to provide you with more information about what is available.

At Colorado State University, students can engage in an online Bachelor’s in Healthcare Administration. This degree program can help students gain more insight into the healthcare field and what is included beyond the scope of doctor/patient practice.

Within this program, students can learn more about treatment efficiency, billing for services and insurance claims. Students can also gain more information about leadership skills relevant to the busy healthcare field and methods to provide a welcoming environment for patients. This program can take around 4 years to complete for most students, with 120 credit hours being required for graduation.

Health Insurance Specialist Example Courses

Healthcare Reimbursement

A large part of the healthcare administration program may be a look into the finance-related components of an effectively-operating facility. In this course, students can learn about the various methods of healthcare reimbursement common within the health field. This can include a look into how insurance claims are paid, outstanding balances are collected and methods for managing challenging scenarios that can occur on a regular basis. Programming such as budgeting and income-based payment plans may also be discussed throughout this course.

Healthcare Management and Policy

More important components of working in healthcare and insurance may be knowledge of policy. Policies can play a role in how professionals within this field conduct everyday business. As health insurance specialists, it may be vital to become knowledgeable about the rules, policies and regulations related to patient care and insurance filing. Having a knowledge of this aspect of healthcare administration can assist in providing a more solid backing for professional success.

Healthcare Economics

Health insurance specialists may be required to stay up to date on current economic considerations within the healthcare field. This component can prove to be helpful by providing professionals with pricing options, current treatments costs and supply/demand information. This course can outline each of these topics in a way that can be beneficial for insurance specialists within hospitals and medical facilities all over the country. General information regarding the state of the economy may also be discussed, as well as the influence of overdue medical accounts on the financial standing of healthcare organizations.

What can I earn as a Health Insurance Specialist?

Health insurance specialists can provide a priceless service to the healthcare facilities they serve. As part of their general job description, these professionals may be responsible for ensuring payment on patient services – part of the healthcare field that presents a large amount of challenges for these agencies in the U.S.

As a specialist in health insurance, you could be the leading source of outreach and communication with health insurance agencies responsible for paying for patient services. If you are interested in the earning potential of professionals within this line of work, check out the salary figures listed below.

What skills are required for success in this position?

As a health insurance specialist, you may need to use a variety of skills on a daily basis in order to effectively manage your position. Within this field, you may be responsible for analyzing a large amount of patient files regularly, contacting insurance agencies and being knowledgeable about what types of services your organization provides to customers.

The need for providing knowledgeable explanations may also be required, in addition to providing insight and leadership to medical billing and coding specialists. If you would like to learn more about relevant skills for this career field, read more in the list below.

Experienced with Technology

In hospitals and medical facilities all over the country, technology may be changing the way that patient information is stored. Since a lot of hospitals rely on the use of computer information systems for their information, upcoming health insurance specialists should be prepared to work primary from these systems. On a daily basis, you may be required to review client files via the healthcare centers computer systems. Information and communication may also be transmitted through the use of technology, making this an important skill for upcoming professionals to obtain.

Great Analysis Skills

One of the primary responsibilities of health insurance specialists may be to analyze the patient records of a hospital in order to ensure that the information provided within is accurate and reflective of the treatment provided. Professionals that begin a career a health insurance specialist should have strong analytical skills that can assist during the analysis of patient files on a regular basis. These types of skills can help professionals to identify inconsistencies within a client’s file that can hold up the insurance process and potentially delay payment if not corrected.

Close Attention to Detail

Health insurance specialists may spend a lot of time combing through treatment information and insurance claims filed by their organization. Having the ability to notice small details and correct them can be a helpful element in performing this job at one’s maximum potential. If you are the type of person that pays close attention to detail and easily notices things that are out of place, this could definitely be a career field for you to consider.