Medical Insurance Specialist
A Level II (Complex Skills Certificate) certificate designed to provide entry-level skills for medical billing specialists. These individuals process the information necessary for reimbursement of health care services. The medical insurance biller is responsible for collection of preadmission/pretreatment insurance information through submission of claims to insurance carrier or patient. Verification of insurance coverage and determination of whether any predetermination, pre-certification, or second-opinion requirements exist is another important aspect of the job.
Training is provided in verification of insurance coverage, assignment of diagnostic and procedural codes, as well as both manual and computerized claim preparation. Review and follow-up procedures for the major carriers are included in addition to posting and balancing of accounts. Students will be able to recognize, evaluate, and interpret inconsistencies, discrepancies, and inaccuracies in the billing procedure. Physician billing as well as facility billing procedures are developed.
Medical Insurance Specialist is the second stage of the three step program option. The students may elect to stop-out at the end of any one of the three stages depending upon their career and educational objectives.
- Medical Receptionist, Level I Certificate, 16.5 credit hours
- Medical Insurance Specialist, Level II Certificate, 46 credit hours
- Medical Practice/Facility - Business Management Associate in Business degree, 70 credit hours
Interested students must work closely with the Health Career Advisor in order to develop their own individual educational plan. For additional information or an appointment, students should contact the Health Careers Office at (313) 845-9877.
- Demonstrate the process of producing procedural and diagnostic claims for the major insurance carriers, both manually and electronically.
- Demonstrate the correct process of insurance procedures in the areas of physician and facility billing.
- Communicate effectively with clients, providers, and insurance agencies.
Admission to the program is based on upon satisfying the following admission requirements:
- A minimum high school grade-point-average of C+ (2.5) or a minimum average score of 55 on the GED test, or a minimum college grade-point-average of C (2.25) for both transfer students and Henry Ford College students.
- A COMPASS Reading score of 84 or higher or successful completion of ENG 081.
- A COMPASS Pre-Algebra score of 39 or higher or successful completion MATH 074 with a C grade or better.
- Health Careers typing test at 45 words/min or better or successful completion of BCA 101 Computer Keyboarding with a grade of B or better
Required Core Courses
Required Support Courses
- Adherence to the program requirements outlined in the MOA/MR/MIS Student Handbook.
- Achievement of a minimum grade of C or better in all MOA required core and required support courses.
- Maintenance of an overall cumulative GPA of 2.25 or better.
HFC continuously attempts to improve each program, and as a result courses and requirements may be modified. Curriculum, course content, and admission criteria are subject to change by action of the College faculty and administration.
Requirements are Subject to Change
Upon completion of the Medical Insurance Specialist program students are eligible to take the certification examination for Certified Medical Administrative Specialists (CMAS). Students may also consider taking the Certified Medical Billing Insurance Examination (CMBI) offered by the American Association of Professional Coders. These credentials are necessary for employment in administrative medical office duties.
The employment outlook for medical insurance specialists is good, but very competitive especially for entry-level positions. Information about career placement is available through the College Placement Office which also assists students in finding employment.
All health care employers are now requiring criminal background checks and drug screens of their new applicants. Students must complete criminal background check and drug screen per Michigan Public Health Code 20713 for admission into the Medical Insurance Specialist program - see below.