Medical Insurance Specialist program fact sheet (PDF)

ALLEGHENY  
Certificate (595.2)

This program provides training in the area of medical insurance and health care claims processing, as well as CPT and ICD coding and computerized medical billing. This program also serves the needs of health care personnel interested in upgrading their professional skills.

Upon successful completion of the program, the graduate will:

1. Evaluate a patient's insurance coverage, differentiate between health insurance and worker's compensation situations and apply guidelines for claims submission set forth by the appropriate insurance carrier.
2. Collect and analyze documentation from a patient's chart to select and apply appropriate diagnostic and procedural codes to insurance claims.
3. Differentiate between a primary insurance claim and a supplemental claim and apply information appropriately to each insurance situation.
4. Manage new claims submission, payments received in office, submission of supplemental claims, corrections and appeals of claims in a timely manner.
5. Apply critical thinking skills and problem solving skills to claims denials for successful appeal submission and reimbursement.
6. Identify medicolegal issues and adhere to guidelines, rules, regulations and laws governing them to maintain compliance in the health care practice.

Upon graduation, a medical insurance specialist may seek employment in physician practices, hospitals, insurance companies and billing services. Graduates may apply their credits toward other select certificate or associate's degree programs.

Students must make separate application to this program. Applicants must be eligible for ENG-100 Basic Principles of Composition and have completed DVS-101 College Reading 2 or DVS-103 Advanced College Reading and Study Skills as required.

See the graduation checksheet for this program in printable PDF form.

Certificate Requirements

Minimum Credits to Graduate: 26

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