Jun 21, 2024  
2023-2024 Catalog 
2023-2024 Catalog [ARCHIVED CATALOG]

Medical Insurance Specialist, Certificate (595.2)

Location(s): Allegheny Campus

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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 submissions, 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 applications to this program. Applicants must be eligible for ENG 100 - Basic Principles of Composition  and have completed CRE 101 - College Reading 2  or CRE 103 - Advanced College Reading & Study Skills  as required.

See Medical Insurance Specialist Program for more information.

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