Health Insurance Specialist Career
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Health Insurance Specialist Career
Ahmad Alanazi
442911529
Overview
A health insurance claim is the written request for payment for medical services made to a third-party payer or government program. Insurance businesses that want to stay competitive are adjusting processes to save expenses overall and administrative costs. The entire claims procedure is being examined more closely as a result of this cost-cutting initiative.
Overview
Health Insurance Career Opportunities
Health Insurance Career Opportunities
According to the U.S. government's Occupational Outlook Handbook Health care institutions, insurance firms, and the Department of Labor's Bureau of Labor Statistics will all expand their hiring of claims examiners specialists in health insurance to process standard medical claims by 9 to 17 percent through 2014.
Health Insurance Specialists
Health Insurance Specialists
- Review medical claims to ascertain whether the costs are reasonable and the claims are medically necessary.
- Every procedure or service code provided on the claim must be connected to an ICD-9-CM condition code that explains the medical necessity for conducting that procedure or service.
Coding
- ICD serves a broad range of uses globally and provides critical knowledge on the extent, causes and consequences of human disease and death worldwide via data that is reported and coded with the ICD.
- ICD-11, was adopted by the 72nd World Health Assembly in 2019 and came into effect on 1st January 2022.
Coding
Job Responsibilities
Each health insurance specialist that works in multispecialty practices often processes claims for a limited number of insurance providers.
Job Responsibilities
Health Insurance Specialist Job Description
Health Insurance Specialist Job Description
- Review patient record documentation to accurately code all diagnoses and procedures.
- Research and prepare appeals for all underpaid, unjustly recoded, or denied claims.
- Explain insurance benefits, policy requirements, and filing rules to patients.
- Maintain confidentiality of patient information.
Scope of Practice and Employer Liability
Self-employed health insurance professionals are regarded as independent contractors. A person who performs services for another under an express or implicit agreement and who is not subject to the other's control, or right to control, of the way and means of performing the services is referred to as an independent contractor in the 'Lectric Law Library's Lexicon.
Scope of Practice and Employer Liability
Professionalism
Professionalism is defined by the Merriam-Webster Dictionary as the behavior or qualities that distinguish a professional individual.
Professionalism
Attitude and Communication
Attitude and Self-esteem
“For success, attitude is equally as important as ability.”
Communication
“And he goes through life, his mouth open, and his mind closed.”
Conflict Management
Conflict Management
“When angry, count to ten before you speak; if very angry, a hundred.”
Customer Service
“If we don’t take care of our customers, someone else will.”
Leadership
“The difference between a boss and a leader: a boss says, ‘Go!’ A leader says, ‘Let’s go!’”
Diversity Awareness
“The real death of America will come when everyone is alike.”
Leadership
Productivity
“Even if you are on the right track, you’ll get run over if you just sit there.”
Managing Change
“If we don’t change, we don’t grow. If we don’t grow, we aren’t really living.”
Productivity
Professional Ethics
Professional Ethics
“Always do right—this will gratify some and astonish the rest.”
Team-building
“Michael, if you can’t pass, you can’t play.”
Conclusion
- A career as a health insurance specialist is demanding and necessitates professional training in order to comprehend billing and claims processing rules, have proficient coding abilities, and successfully appeal refused or underpaid insurance claims.
- A scope of practice that describes the profession, specifies qualifications and responsibilities, and makes supervisory requirements clear serves as a guide for health insurance professionals.