Medical Insurance and Reimbursement Specialist
Learn to increase revenue and apply compliance by guidelines. Translate written documentation into numerical language, identify and code services on a CMS – 15 claim form. Major health insurance programs and government sponsored programs will be discussed with an emphasis on Federal and State plans: Medicare, Medicaid, and commercial carriers. Students will become familiar with insurance terminology. Students will learn the responsibilities of departments within the insurance company, claims processors, how to interpret insurance contracts, how to calculate UCR and create fee schedules utilizing RBRVS, and how to process health claim forms. The student will learn to differentiate between basic comprehensive and major benefits, understanding benefits, eligibility, coverage, COBRA, contract provisions, investigate third party liability. The student will learn reasonable fees, understand, create, and evaluate physician fee schedules, compliance, electronic data exchange, HIPAA, OIG, and guidelines.
CMRS exam: the 16-module computerized exam will be administered in class. The Exam fee includes an AMBA (American Medical Billing Association) membership and study guide. This fee is in addition to the course fee. The instructor will provide information for exam payment and membership.
Session(s) Currently Offered