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How do I Become a Reimbursement Specialist?

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  • Written By: Lainie Petersen
  • Edited By: Melissa Wiley
  • Last Modified Date: 26 June 2019
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If you would like to become a reimbursement specialist, you should complete a training program in medical coding and billing and then complete a certification exam offered by a recognized professional organization. In the United States, many people become reimbursement specialists after completing an associate's degree or, in some cases, a certificate program and then passing an examination offered by the American Medical Billing Association. Reimbursement specialists who pass the exam can then receive certification and must usually complete yearly continuing education courses in order to maintain their certification.

Medical reimbursement specialists work in health care settings and specialize in submitting claims to health insurance companies. To do this, they need to have an understanding of medical terminology as well as insurance rules and policies, along with a thorough knowledge of pertinent health care privacy laws. After submitting initial claims to health insurers, medical reimbursement specialists must then address any claim denials. This can be a lengthy process as the reimbursement specialist selects appropriate coding for insurance purposes and then attempts to refine and change the submission when appealing a denial of benefits from the insurer.

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While formal education and certification are not absolutely required to become a reimbursement specialist, employers typically want to hire reimbursement specialists who have such training and certification. Medical reimbursement is not a licensed profession in the United States, but the American Medical Billing Association does sponsor a nationally recognized certification program. The certification process involves completing an exam that consists of 16 parts. Knowledge tested includes medical terminology, different coding types, and insurance fraud. Formal training is not required to take the exam, though the American Medical Billing Association advises individuals to not take the exam if they have no knowledge of medical coding. Once you pass the exam, you can become a certified medical reimbursement specialist (CMRS). To maintain your CMRS credentials, you will need to complete 15 approved continuing education units each year.

Education and training programs to become a reimbursement specialist vary in scope. In the United States, both community colleges and trade schools often offer medical coding and billing courses and programs. The curriculum is usually a blend of specialized courses, including anatomy and physiology and medical terms, along with more general courses such as customer service, keyboarding, and office management. Since many reimbursement specialists may, at least initially, perform general medical office work along with their billing duties, a broad knowledge of business office practices is often a good addition to a reimbursement specialist's training program. If you wish to advance in your career, you may need to complete an additional academic degrees or certification programs in order to enter into health information management.

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