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How to Become a Reimbursement Specialist

Looking to enter the insurance industry? If so, getting a job as a reimbursement specialist may be the best next step for you in your career path. As a reimbursement specialist, you’ll be entering an entry-level position that deals with processing and investigating insurance claims. To be a good candidate for this role, people will need prior customer service experience along with a general knowledge of medical insurance and health benefits.

Reimbursement specialists are found working in hospitals and other healthcare facilities to help patients handle their medical bills with their insurance company. They are responsible for working with insurance and billing staff to manage payments and various reimbursements. It is important for reimbursement specialists to regularly update patient files and adhere to confidentiality and HIPAA laws. 

This job opportunity is perfect for anyone looking to expand their knowledge and gain experience with insurance after their high school graduation. Becoming a reimbursement specialist will teach you to communicate effectively and to better work with others, which will prepare you to get a higher position in the insurance sector. 

Sample job description

Reimbursement specialists are responsible for communicating and working with insurance companies and medical billing staff to manage billing and various reimbursements. This position requires an advanced understanding of records, coding, and billing practices to ensure compliance and patient confidentiality. If you want to be in a medical setting where you don’t have to be up and running, becoming a reimbursement specialist may be the right career for you. [Your Company Name] is searching for a compassionate reimbursement specialist that has a gift for working with others by listening and trying to fulfill their needs to their best abilities. If you have been in a previous insurance role and have strong organization skills, you may be the perfect candidate to fulfill our open position as a reimbursement specialist.

Typical duties and responsibilities

  • Process claims quickly and accurately to ensure there are no errors
  • Update patient medical files
  • Investigate claims issues and make recommendations for process improvement
  • Understand insurance carrier guidelines and stay abreast of any changes that occur to communicate them to management and staff
  • Adhere to confidentiality, state, federal, and HIPPA laws and guidelines with regards to patient’s records

Education and experience

This position requires a high school diploma or GED.

Required skills and qualifications

  • Understand medical terminology, accounts receivable, insurance collections, and billing
  • Expertise in written and verbal communication
  • Ability to think independently
  • Excellent interpersonal skills
  • Ability to recognize and deal with priorities

Preferred qualifications

  • 2 years of experience in a call center/customer service-oriented role that requires attention to detail and basic computer skills
  • General knowledge of benefits, healthcare, medical/pharmacy insurance is a huge plus

Typical work environment

Reimbursement specialists are found in a variety of medical and insurance settings, such as physician’s offices, nursing homes, insurance companies, medical software firms, and more. Reimbursement specialists can expect to work independently in an office, where they will be on phone calls with patients and insurance companies throughout the day. While most reimbursement specialists work the typical 40 hour work week, some may have to work longer hours depending on the season and the company. 

Typical hours

The typical work hours for a reimbursement specialist can be from 9 AM to 5 PM, Monday through Friday, in an office setting.

Available certifications

There are often required certificates reimbursement specialists have to earn to demonstrate their knowledge about insurance and health care. Here are some of the most popular certifications to earn: 

  • Certified Professional Biller (CPB). The Certified Professional Biller prepares its students to become expert medical billers. The course provides all the resources needed to learn how to properly submit claims, follow up on claim statuses, resolve claim denials, submit appeals, and make adjustments while always adhering to government regulations. Earning this certification would be the best next step to furthering your career as a reimbursement specialist once you graduate high school or earn your GED.
  • Certified Billing and Coding Specialist (CBCS). Having basic coding skills is essential to becoming a reimbursement specialist. This certification will teach proper medical coding, so every participant learns how to properly submit medical claims with specific diagnostic codes required for correct payments. The course also teaches how to prevent fraud by understanding how to audit billing. The CBCS not only teaches valuable skills each reimbursement specialist needs, but also how to achieve optimal reimbursements by negotiating with insurance companies and healthcare providers. Becoming a certified billing and coding specialist will make you a competitive applicant and a desirable candidate to many firms!

Career path

The career path for a reimbursement specialist starts by first obtaining a high school diploma or GED. While not always necessary to start, employers often prefer candidates that have earned certification through a professional organization like the American Medical Billing Association.

US, Bureau of Labor Statistics’ job outlook

SOC Code: 29-2098

2020 Employment335,000
Projected Employment in 2030363,600
Projected 2020-2030 Percentage Shift 9% increase
Projected 2020-2030 Numeric Shift28,600 increase

The health care industry is generally increasing in size year after year. More people are accessing health care services and making insurance claims for those services. All this activity creates a growing need for reimbursement specialists and people working in the health care billing field.

One reason for this growth is the aging population in the United States. Older people typically need more health care than young people. As the oversized baby-boom generation ages, the demand for health care services generally increases across the board.