A medical claims specialist is also known as a health claims specialist or medical billing specialist, and is an employee who works for a hospital, doctor's office, or insurance company. The medical claims specialist is responsible for assigning the correct insurance and procedural codes to bills, processing insurance forms, and performing patient billing services. Education requirements vary depending on the physician's office or type of billing to be processed.
A medical claims specialist may only be required to have a high school diploma, and often some experience working in a healthcare environment, usually as an administrative assistant. He or she may then receive on-the-job training to be a claims specialist. Some offices or healthcare businesses require their claims specialists to have an associate's degree in health information technology, however, along with one of the following certifications: Certified Coding Specialist (CCS), Certified Coding Associate (CCA), or Certified Coding Specialist-Physician-based (CCS-P).
Many community and vocational colleges offer classes or certification programs in this type of work. Students learn medical terminology as well as the billing codes necessary for submitting claims to insurance companies. These are known as Current Procedural Technology (CPT) codes and International Classification of Diseases (ICD) codes. It is important for a medical claims specialist to know and understand insurance laws in order to process the claims correctly.
In addition to filling out forms for insurance companies, a medical billing specialist will also need to process payments received from patients and insurance companies, and apply them correctly to various accounts. Disputes often arise between patients and insurance providers, and a medical claims specialist will likely need to spend much of his or her day on the phone resolving these issues, so it is important for a claims specialist to have good customer service skills, and the ability to multi-task efficiently. Medical claims specialists frequently answer questions regarding billing or insurance when patients call the office or call center at a hospital.
Medical claims specialists will need to be neat and organized, as their job will frequently require maintaining a file system. They need to have excellent computer and data entry skills, and a high attention to detail. Some medical claims specialists are able to work from home, once they have established themselves as efficient and careful workers within an office. Typically, a medical claims specialist will work regular weekday hours, and receive a fairly good income with benefits; this makes this career a good choice for many people.