Health insurance is the primary source of revenue for most healthcare systems and facilities including clinics, small physician's practices, and long-term healthcare facilities. In this position, you'll file insurance claims that patients rely on for their treatment and the organization relies on for revenue. In fact, you'll find that this job not only has a technical, financial side but also a human side in that you will find yourself in touch with patients, their families, and clinical workers, too.
Students who are interested in starting a career in healthcare should consider this as a terrific entry point for fantastic career. It can lead to great things including work in insurance underwriting, medical records and billing, and health information technology careers. This page is dedicated to health insurance specialists and related fields.
What is a Health Insurance Specialist?
A health insurance specialist is a healthcare administration professional who helps patients with their insurance claims. They work as an intermediary between the patient, the providers, and the insurance companies. They are responsible for reviewing claims and ensuring that the patient receives adequate care and that their insurer will cover the necessary procedures. If the insurer does not cover all of the costs of a procedure, they will work with the billing department to send the remaining bill to patients.
Steps to Become a Certified Health Insurance Specialist:
To become a health insurance specialist, you will first want to decide that healthcare is the field for you. Many healthcare administrators are inspired to pursue this career when they see how helpful it can be. Though it’s not as hands-on as being a physician's assistant, nurse, or physician, the financial aspect of healthcare is undeniable. Thus, those with a business mind who may be squeamish around blood or surgical procedure should consider this career path.
The first step to becoming a health insurance specialist is thus to decide that you want a healthcare career that has an immediate positive impact on people's lives while also providing lots of growth opportunity and a good salary, too. Insurance specialists should have a good head for legal documents, medical terminology, and finance. One practical step to take toward being a healthcare administrator is to volunteer at a local hospital. There are also entry-level positions in healthcare administration, clinical work, and even a retail job inside a hospital can provide valuable exposure and insight into how hospitals work on a daily basis.
Once you've decided that you want to pursue a job as a health insurance specialist, you need to find a healthcare administration degree that will help propel you to success. Since this job does not require a bachelor’s degree, or any post-secondary degree at all, you might start off with an associate degree in healthcare administration or a certificate. It's recommended that you start with at least a two-year associate degree. If your local community college doesn't offer the specific healthcare courses you seek, you can investigate online degree programs.
Alternatively, you can pursue an associate degree that will provide the skills you need. For example, you may be able to take medical coding as an elective while studying accounting, finance, or business management. When you complete a two-year degree you not only will have the specific courses you need to get started in your field, but you'll have completed the core curriculum you need to move on to a bachelor’s degree program.
After you've completed your degree and have the skills you need to succeed in healthcare administration as a health insurance specialist, you can begin applying for entry-level positions. You can seek a job with a small clinic, a hospital, or a long-term care facility, to name a few options. When you first start, there may be a significant learning curve before you're fully on-board with all of your duties. However, you'll soon master the position.
Once you're settled and are managing healthcare claims for numerous patients every day, you can consider more training. One first step might be to seek out a professional certification. One possible certification is the Certified Medical Insurance Specialist (CMIS). Once you attain this credential, your employer will find you more valuable and you will also be more desirable if you seek other employment.
When you're ready, you may want to return to school and complete a bachelor’s degree. If you already have an associate degree, you're basically halfway there. Your two-year degree should provide the credits you need to satisfy the core curriculum requirements of most four-year bachelor’s degree programs.
For your bachelor’s degree, you can choose any path you want, but if you still enjoy working in healthcare administration, you can seek out a program that caters to that specific industry. There are many degree options out there including a Bachelor of Science in Healthcare Administration, Bachelor of Healthcare Administration, and Bachelor of Healthcare Management, to name a few options. You can also work toward a standard management degree because your experience in healthcare should inform your academic work.
What Does a Health Insurance Specialist Do?
A health insurance specialist works in an office environment, often in a hospital. However, they may conduct their duties from a separate office or even from home, depending on the rules governing the facility. On a day-to-day basis, a health insurance specialist oversees a caseload of patients who are receiving treatment for a variety of illnesses. Some insurance specialists work with certain types of patients based on the department or facility they work for. This helps them gain an intimate familiarity with the medical terminology and procedures. For instance, some may specialize in patients on the maternity ward, the oncology ward, or the mental health ward.
A health insurance specialist is responsible for ensuring that patients receive the care they need while makings sure that the insurance company will cover the payments. They also manage any co-pays that patients must provide as a condition of receiving care. Essentially, a health insurance specialist is an expert at reading insurance policies and filing claims for payment. They are well-versed in medical coding and insurance protocols and can thus file claims in an efficient and timely manner. Their expediency helps give patients and providers the green light for surgeries, therapies, and other forms of care.
Health Insurance Specialist Skills to Acquire
- Medical Coding:
This is an imperative skill. When you submit a claim to an insurance company, they will need to see the proper codes on the paperwork in order to process the claim. If you enter the wrong code, they may deny a claim or approve a claim based on faulty information. Either way, both the provider and the patient can be harmed.
- Communication Skills:
You'll need to be able to communicate with healthcare providers including physicians, surgeons, physical therapists, and more. When you are fully knowledgeable as to why a patient needs a specific treatment, you can convey that to the insurer and hopefully receive payment for the procedure. This field also requires that you communicate delicate financial information with family members and patients, who are likely to be in various states of distress.
- Financial Knowledge:
Insurance is a financial instrument. As such, you'll need to understand how premiums, deductibles, and co-pays all work. This way you can explain to patients and their families how the billing and insurance all works. There may even be other ways to finance one's healthcare plan including heath savings accounts, primary care memberships, and high-deductible policies. These options may involve interest payments or other complex financial attributes that you will need to explain.
Since there is no specific degree or licensing requirement for a health insurance specialist, there are many routes into the profession. One of the fastest routes may be to pursue a one-year certificate program through a local community college or an online institution. You might even start in a medical assistant program, which should provide the administration skills you need to get started.
Another route would be to start with an associate degree. You might major in a field like accounting, business management, or healthcare administration. However, if you have some other two-year degree and now wish to transition into a job as a health insurance specialist, you can always take a course in medical coding, healthcare finance, or healthcare accounting as a way to reposition yourself for the new career path.
Those with some other degree, unrelated to healthcare administration might consider working towards a professional certification such as a Certified Medical Insurance Specialist (CMIS) which should provide ample credentials and help you thrive. Once certified, you can apply to any healthcare provider who is hiring in your field.
Finally, one way to get started in this field is to land a job in a hospital or doctor's office such as a dentist, chiropractor, or dermatologist. With a high school diploma, you may start work on the front desk, helping patients schedule appointments, and answering the phones. Soon you'll begin to grow and develop more administrative skills.
Health Insurance Specialist Career & Salary
Where Might You Work?
Health insurance specialists can work in a number of healthcare environments. While they most often are thought of as hospital workers, your career can include work in small clinics, dentist offices, chiropractic clinics, and with any other healthcare provider that relies on insurance reimbursement as its primary revenue source.
If you work in a hospital, you might be assigned to work with special populations within a specific department. Some health insurance specialists work with cancer patients and their families. Others might work with maternity patients. No matter what your specialty area, you will need to gain a familiarity with the typical surgeries, therapies, and other sorts of health insurance claims that are germane to that medical specialty. Though there may be some overlap, each specialty area will have medical codes that you'll use all the time.
You will also have to adapt your communication for each area. If you work in a long-term healthcare facility you will likely be communicating more with family members than the actual patients. The same applies at the other end of the age spectrum if you work on a pediatric ward and must work with distraught parents regarding their child's healthcare picture.
According to the U.S. Bureau of Labor Statistics (BLS), the outlook for those in the medical records and health information fields is quite good. The BLS doesn't specifically address health insurance specialists, but they are likely to be comparable to those in medical records and health information. These healthcare fields that are reporting a median salary of $43,000 with a typical worker holding a non-degree award such as a certificate. Some sources show that medical billers and coders with added credentials can earn salaries as high as $70,000 and management can earn as much as $100,000.
Since the healthcare industry is growing by leaps and bounds, so is this specific healthcare specialty. In fact, the BLS projects 8% growth for this job for the ten years between 2019-29. Other comparable fields such as medical assistants, medical transcriptionists, and pharmacy technicians are reporting median salaries around $35,000 with projected growth that is far lower than that of those in medical records and health information.
The healthcare industry offers many opportunities for eager professionals. In fact, there are perhaps as many specialty areas on the administrative side as there are in the clinical arena. The good news is that no matter which side of the healthcare world you find yourself on, you are still serving the chief goal of helping patients recover from their illness or injury so they can live healthy, happy lives.
Here are a few jobs that are comparable to health insurance specialist. Keep in mind that some who have started in medical billing end up as hospital administrators or even the CEO of a healthcare system. This is only a small sampling of what is available in the broad area of healthcare administration:
- Medical Coder:
This position is a vital part in the life of any healthcare system or medical practice, including small clinics and long-term healthcare facilities. There are also positions available in environments including psychiatric hospitals, pediatrician's offices, and more.
- Medical Billing:
In order to succeed in this position, you will probably want to have a certificate that attests to your medical coding skills. Certified medical coders may garner higher salaries and receive larger bonuses and raises.
- Medical Records:
This position is extremely important since a patient's treatment may depend on how well their records are kept. To have the best chance of success, strive to earn a certification as a Registered Health Information Technician (RHIT); alternatively, Registered Health Information Administrator (RHIA) credentials are equally valid.
- Medical Assistant:
This position is for those who enjoy working on both the administrative and clinical side of healthcare. After a few years as a medical assistant, you may decide to specialize in medical billing, health insurance, or even return to school and become a nurse.
Find Health Insurance Specialist Jobs Near You
Advancing from Here
Health insurance specialists have a lot of room to grow. From this position you can work your way into management and supervise a team of medical coders and billing experts and others. If you are particularly drawn to technology, a related field is healthcare informatics, which deals more with health records and their databases. Still others may complete their bachelor’s and master’s degrees in healthcare administration and rise through the upper ranks of their hospital and work in the C-suites of a booming healthcare corporation. After all, where better to start than where the money first enters the system?
Healthcare Career Paths