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Coding and Reimbursement Specialist

The role and Responsibilities/Tasks of Coding and Reimbursement Specialist include:

  • Health care reimbursement specialists handle all aspects of insurance claims processing
  • Spotting and investigating details in insurance claims that may indicate fraud or unwarranted medical treatments or procedures, insurance coverage abuse
  • Reviewing claims returned or rejected by government or supplemental insurance companies
  • Responding to medical and customer inquiries regarding coverage and explaining rejections related to alleged experimental treatments or questionable procedures
  • Checks if the final diagnoses and operative procedures as stated by the physician are valid and complete
  • Analyses all necessary information from health records to identify secondary complications
  • Assigns codes which most accurately describe each documented diagnosis, surgical procedure and special therapy or procedure according to established guidelines
  • Questionable codes are researched and coding guidelines are deciphered for appropriate code assignments
  • Regularly monitors any coding changes or coding regulation changes
  • Specialist also needs to decipher many procedures which are abbreviated terms or codes to determine eligibility for coverage

Salary Range

  • Coding and Reimbursement Specialist average earning capacity in 2012 ranges anywhere between approximately $37,000 - $48,000 per annum depending on organization size or type, area, expertise, industry and so on (figures taken from industry sources)

Certification Needed

Minimum Qualifications- Coding and Reimbursement Specialist needs to possess any one of the following:

  • A certificate or associate degree in health care reimbursement
  • A minimum of a high school diploma or equivalent plus at least two (2) years of coding and reimbursement experience in a physician group, clinic or academic healthcare setting
  • Certifications from professional associations are an additional requirement for some reimbursement specialist position

Additional certifications generally include-

  • The American Health Information Management Association (AHIMA) certification for Registered Health Information Technicians (RHIT), which requires to be a graduate of an accredited two-year associate degree and passing a written exam
  • The American Academy of Professional Coders (AAPC), the Board of Medical Specialty Coding and Professional Association of Health Care Coding Specialists - different credentialing in coding and specialized coding (RHIA, RHIT, CCS, CCS-P, CPC, CCA, and CPC-H)
  • Successful completion of ICD_10 (minimum version 2) Introductory qualification
  • Completion of the intermediate coding course is an added benefit

Other skills required include-

  • Attention to detail is important to be a successful reimbursement specialist
  • Research skills are imperative to interpret new medical and insurance industry terminology
  • Added advantage to be posses skills to resolve problems with rejected or disputed claims
  • Computer and medical coding skills are vital for this role
  • Specialization in clinical classification and health care reimbursement methods
  • Knowledge of Health care environment and commitment to accuracy
  • Knowledge of Quality Assurance and accreditation principles

Work Environment

  • This position being a is a medical administrative support one is found at hospitals, clinics and nursing and outpatient care facilities as well as insurance and medical billing companies
  • Hours are usually general 9 to 5 shifts, Monday through Friday
  • Work is in a business office atmosphere and includes a lot of computer and telephone communication
  • Demand for trained health care reimbursement specialists has been fueled due to the changing federal and state regulations regarding reimbursement for health care services
  • According to BLS, employment in medical records technology is expected to grow at a faster rate than employment in other industries through 2016, health care reimbursement specialists with a strong background in medical coding will be in especially high demand.
Coding and Reimbursement Specialist can post their details with us to access the best opportunities across all US states and varied specialties.
If your hospital or clinic needs a Coding and Reimbursement Specialist, register your details with us and we can get one in your specialty or location preference.

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