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Medical Insurance Specialist skills are needed in physician’s offices, hospital departments, medical centers, clinics, surgery centers, specialty clinics, health care related agencies, ambulatory centers, emergency facilities, medical supply companies, insurance companies, dental offices, chiropractic offices, rehabilitation centers, physical therapy centers, nursing home facilities, government agencies, billing companies, most all medical or health related facilities. Learn the skills needed for working in a medical facility or open a billing insurance business. Medical insurance jobs are a crucial link between patients and health insurance companies. Focusing on the financial side of medical, you could be looking at a very rewarding career. You will have the opportunity to learn skills needed in Insurance, HMOs, Billing, Physician's Charges, Posting Payments, Coding, all the way to Hospital Billing, Reimbursements, to Claims Processing, all-in-one program. Hands-on applications for practice and mastering learning concepts with case studies, documents, and computer software practice is included for maximum results. Start at beginners level and advance to a professional expert level in training. Medical Insurance Specialist salary can range from $19,700 to $38,800 depending on facility, title, experience, and knowledge. |
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Learn vital skills that play an important role everyday in health care operations and business. Become familiar with the rules and guidelines of each health care plan in order to submit the proper documents so the office receives maximum appropriate reimbursements for services. Development an understanding of how to bill both payers and patients. Learn communications skills needed to effectively work with physicians, patients, and other members of the health care team and payers. Provides an understanding of diagnosis and procedural coding to prepare you to effectively and efficiently submit claims in accordance with payer's requirements. Covers HIPAA rules, billing points, and ensuring compliance with the correct billing and coding practice. Claim case studies and computer applications let you practice your knowledge for correctly preparing primary and secondary claims for real world practice and applications. Program Overview: Understanding the billing process. Medical insurance terms, health care benefits, covered and non-covered services. Group and individual insurance policies Health Care Plans and determining what charges are medical necessary and covered by the insured 's health plan. Learn how to determine the patient's payment for the premium, deductibles, and co-insurance. Learn how to calculate charges, deductibles, patient's payment. Understanding the Health Plan payment and balances due. Managed Care and Managed Care Organizations. Health Maintenance Organizations Medical Management Practices in HMOs and types of Capitation and examples on how to calculate a capitated payment. Responsibilities of the Medical Insurance Specialist and the Billing Process. Preregistering and Registering Patients Establishing the financial responsibility for the visit Checking In Patients, Checking Out Patients The Billing Process. Steps and guidelines to follow. HIPAA and Medical Records. Understanding documents and encounter forms. Vital information that is needed for each patient's visit and assembling. Health Care Regulations Federal Regulations, State, and HIPAA Rules. Complying with HIPAA with guidelines to follow. HIPAA Electronic Health Care Transactions and Code Sets. Fraud and Abuse Regulations. Programs and Plans. The Billing Process. Gathering patient information. Preregistering and Registering New Patients and Scheduling. Steps and guidelines to follow. Established patients and procedures to follow for registering and scheduling. Documents and reports needed. Establishing the Financial Responsibility of the Patient. Verifying patients eligibility for benefits. Verifying Amounts, Copayments, Checking Out-of-Network Benefits, Covered Services. Electronic Benefit Inquires. Determining Preauthorizations and Referral Requirements. Who is primary and secondary. Patients Diagnosis, Procedures, and Charges. Collecting Payments. Who to Bill First? Patients or the Insurance company. Estimating what the patient will owe. Making financial arrangements. Taking payments and methods Coding ICD-9-CM Diagnosis Coding. Understanding, organization, categories, subcategories, and classifications. Understanding the symbols, notes, punctuation marks, and abbreviations. Multiple codes, V codes, and E codes. Steps and guidelines to follow for correct diagnosis coding. Official Coding Guidelines, Steps, and Procedures. Overview of ICD-9-CM chapters, guidelines, and steps needed for accurate coding are described. Coding CPT Procedural Coding. Understanding organization and categories. Guidelines to follow for correct CPT coding, formats, symbols, modifiers. The Appendixes. Coding steps to follow for reporting accurate procedure codes. Understanding Evaluation and Management Codes. Guidelines for coding for Anesthesia, Surgical Codes, Radiology, Pathology/Laboratroy, and Category II and III codes. Understanding HCPCS coding and procedures. HCPCS billing procedures. Charges and Compliant Billing The billing process, billing rules, government regulations, compliance and billing errors. Strategies for Compliance. Audits and the audit process. Fees: Understanding physician's fees and payers fees. Understanding the Payer Fee Schedules and Payment Methods. Calculating the correct fees, who pays, and amounts. Examples for understanding charging fees for clarity. Health Claim Preparation and Claims Transmissions Contents and sections of the CMS-1500 claim form and completing each section in detail with examples and reference tables. Completing the HIPAA 837 Claim. Understanding and guides to follow. Clearinghouses and Claim Transmissions. Transmitting Claims. HIPAA Claim Data Elements for Provider, Subscriber, Patient, and Payer information. Payers: Insurance Carriers Understanding private insurance companies and plans, Features of Health Group Plans. Portability Required Coverages Types of Plans: PPO, HMO, POS, Indemnity, Consumer Driven Health Plans. Mayor Payers. Blue Cross Blue Shield Understanding procedures. Identification Card, Types of Plans. Participating Contracts. The medical billing process- steps and guidelines to follow. Billing Management and Claim Completion Medicare Understanding Medicare and Part A, B, C, and D. Coverages and Benefits. Medicare Participating Providers, Non-Participating Providers, Accepting Assignment, Calculating payment for Unassigned claims and plans Medigap Insurance Supplemental Insurance. Medicare Billing and Compliance. Filing timely claims Duplicating Claims Split Billing Preauthorization Billing Types. Preparing Primary Medicare Claims. CMS-1500 Completion. Medicaid Understanding Medicaid and Eligibility Requirements Types of Plans Payment for Services Difference in Categorically Needy and Medically Needy Income and Asset Guidelines for Eligibility. Services Medicaid does not cover. Types of plans that states offer to Medicaid recipients. Preparing Medicaid claims and filing and Medicaid claims completion. TRICARE and CHAMPVA The TRICARE program Eligibility Participating and Non-Participating TRICARE Standard, Cost, Preauthorization TRICARE Prime, TRICARE Extra Filing Claims and completing the CMS-1500 form guidelines. CHAMPVA Eligibility Authorization Card, Covered Services, Preauthorization, Participating Providers, Cost and Filing Claims. Workers' Compensation and Disability Federal Workers' Compensation Plans, Benefits Covered Injuries and Illnesses. Classification of Injuries. HIPAA Privacy Rule. The Claim Process. Billing and Claim Management. Disability Compensation Programs and preparing disability reports. Payments, Appeals, and Secondary Claims Claim Adjudication The Claim Process Determination of a Claim Receiving Payments and Documents Monitoring Claim Status Claim Turn Around Time and Aging Claim Follow Up Remittance Advice and Explanation of Benefits. Adjustments. The process of reviewing and processing RAs/EOBs. Denial Management. Appeals, Audits, Over Payments, Grievances. Billing Secondary Payers Electronic Claims and Paper Claims MSP Claims and Payments TRICARE Secondary Claims Medicare and Medicaid Cross Over Patient Billing and Collections Financial Policies and Procedures Patient's Statements. The Billing Cycle: Individual Patient Billing Versus Guarantor Billing. Effective Collections Regulations and Procedures Collection, Letters, Calls Credit Arrangements and Payment Plans. Collection Agencies and Credit Reporting. Skip Tracing Writing Off Un-collectible Accounts Patient Refunds and Record Retention. Hospital Billing and Reimbursement Hospital Care Facilities Inpatient, Outpatient. Outpatient or Ambulatory Care, Integrated Delivery Services. Hospital Claim Processing Admissions, Consent. Pretreatment Patient Payment Collection. Records of Treatments and Charges During the Hospital Stay, Documents, Discharge and Billing. Inpatient Hospital Coding. Hospital Procedural Coding. Payers and Payment Methods. Diagnosis Related Groups and DRG Codes Inpatient Prospective Payment System. Claims Completion and Follow Up on Claims. UB-04 Locators Codes. Hospital Billing Compliance. Applications for practice and mastering learning concepts with case studies, documents, and computer software CD applications. Learning opportunities for career success. This program could create many many job opportunities or open a home insurance billing business. _______________________________________________________________________________________ Start Your Career Now, Fill out the contact form below for more information, to register for class, contact us, or have a representative call you. Take on-line or come in for private like classes. |
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