Job Profile: Health Insurance Specialist

Americans spend nearly $8,000 per capita each year on healthcare. Having health insurance is crucial for individuals to reduce their out-of-pocket costs and make medical treatment more affordable. Healthcare providers need to hire professionals to oversee the entirety of the medical insurance claims process.

That’s where health insurance specialists come into the picture. Health insurance specialists make certain that their employing organization is properly paid for medical services provided to insured patients. Health insurance specialists may also be referred to as medical coders, claims examiners, insurance billers, or health information technicians. Their roles vary nearly as much as their job titles, but all health insurance specialists handle every detail involved in medical billing.

Salary

According to the Bureau of Labor Statistics, the 266,280 insurance claims adjusters, including health insurance specialists, in the United States earn a mean annual salary of $63,500, or $30.53 per hour. Health insurance specialists working for insurance carriers earn slightly less at $62,610, but those employed by general medical hospitals make an average of $59,860 annually.

Beginning Salary

When just starting out as a health insurance specialist, it’s likely that you’ll land in the bottom 10th percentile of earnings with a yearly income around $37,580. However, more experienced health insurance specialists who are promoted as health information managers can eventually bring home up to $103,680 each year.

Key Responsibilities

Health insurance specialists are primarily responsible for utilizing patients’ electronic health records to code medical procedures and examine insurance claims. Health insurance specialists maintain meticulous records of medical costs, adjustments, co-payments, and other billing details.

On a typical day, health insurance specialists can be found communicating with insurance carriers, updating internal billing databases, electronically storing patients’ records, filing registration forms, analyzing insurance claims, detecting coding errors, and verifying medical coverage. Some health insurance specialists take an active role in helping patients obtain and understand their medical benefits. It’s their overall duty to follow all regulations and coding procedures to allow for prompt payment of medical services.

Necessary Skills

Working as a health insurance specialist will require basic clinical skills to understand medical terminology and code for different injuries, conditions, or diseases. Health insurance specialists must be skilled communicators with the interpersonal skills to interact with carrier representatives, patients, and physicians.

Analytical skills are a must for health insurance specialists to check for any billing errors and make the necessary modifications. Being very detail-oriented with good organizational skills will help health insurance specialists file all essential insurance paperwork correctly. Health insurance specialists need the technical skills to work with electronic health records, coding software, email, and databases.

Degree and Education Requirements

Health insurance specialists must have extensive knowledge of the latest alphanumeric codes used in medical billing, so post-secondary training is typically required. Employers prefer hiring health insurance specialists who have earned at least a two-year associate’s degree from an accredited college.

Majoring in medical billing, medical coding, health informatics, or health information technology is advised. Make certain that you fill up on electives related to medical insurance claims processing. A bachelor’s degree could unlock supervisory roles in the health insurance field. Attending graduate school for a Master of Healthcare Administration (MHA) or Master of Health Informatics can make you eligible for becoming a health information manager.

Pros and Cons of this Position

As with any career, being a health insurance specialist will provide rewards and challenges that you must be prepared for. On the positive side, health insurance specialists earn an above-average hourly wage and have room for advancement into administration. Health insurance specialists can work in nearly any geographical area across the nation. Job prospects are expected to remain favorable for less hiring competition. Health insurance specialists who get tired of working in healthcare could segue into other industries, such as auto or home insurance.

On the other hand, health insurance specialists often need to invest in certification and training. Health insurance specialists spend a lot of time sitting in an office with little patient contact. Some may find the job stressful since the utmost accuracy is required at all times.

Getting Started

Having prior experience in the health insurance sector will be important. While earning your degree, it’s recommended that you complete a hands-on practicum or internship experience related to medical insurance claims. Specializing in a certain area of medicine, such as pathology, respiratory, cardiac, and oncology, could be helpful for building a niche.

Start working at the entry-level as a medical coder or biller. You’ll develop expertise in processing medical claims, which will help in becoming a health insurance specialist. Becoming certified is the next crucial step. Through the American Academy of Professional Coders (AAPC), you can become a Certified Professional Coder (CPC) by passing an exam.

If you’re looking to broaden your career, pursuing credentials as a Registered Health Information Technician (RHIT) or Registered Health Information Administrator (RHIA) could be helpful.

Future Outlook

After Obama’s administration passed the Affordable Care Act (ACA), the uninsured rate in the United States has dropped to 12.9 percent. Therefore, it’s clear that health insurance is more widely accessible and used today. Demand for health insurance specialists is projected to grow rapidly for this reason.

America’s aging baby boomer population will also be filing more medical insurance claims for tests, treatments, surgeries, and other procedures. The BLS reports that the employment of health insurance specialists will grow by 22 percent through 2022. The best job prospects are expected for specialists with CPC or RHIT certification and formal training. Jobs can be found at hospitals, physician offices, nursing homes, residential care facilities, government agencies, insurance carriers, pharmaceutical companies, and managed care organizations.

Overall, health insurance specialists play a pivotal role in making sure all matters regarding medical billing, payments, and insurance claims are handled in an efficient manner. Health insurance specialists are well-versed in analyzing insurance plans and preparing medical bills using alphanumeric codes.

These professionals review patients’ medical records thoroughly and verify that any insurance claims submitted to providers are justified. Working as a health insurance specialist can be the perfect stepping stone for becoming a health information manager or healthcare administrator later.

If you become a health insurance specialist, you’ll have the opportunity to ensure patients are billed correctly and health delivery systems are paid properly.