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Medical Billing / Claims Analyst

Certificate
(Pending Approval by the State Board of Education)

Catalog Year 2008-09

MHCC Faculty Advisor
Carole Wickham: 503-491-7195 - Room AC 2772 Carole.Wickham@mhcc.edu

Medical billing specialists are vital for the efficient management of all aspects of billing. A medical billing specialists responsibilities can include: expert management of healthcare billing-processing, adjusting and resubmitting of claims; adherence to current healthcare industry regulations and policies; and compliance with insurance procedures and allotted benefit coverage. Billing specialists understand the information on identification cards, distinguish between Medicare and Medicaid, understand Blue Cross/Blue Shield coverage, and Workers Compensation benefits.

A claims analyst uses the same skills as a billing specialist. The duties of a claims analyst may include: overseeing claims processing and payments to third-party providers, monitoring charges and verifying correct payment of claims, sending denial letters on claims, and sending follow-up requests for information. The claims analyst reviews payment reports for accuracy and compliance. Medical Billing Specialists/Claims Analysts can work in hospitals, insurance companies, doctors offices, medical billing companies, nursing homes, medical group practices, home health agencies, and medical clinics. Students who complete this shorter term Medical Billing/Claims Analyst program can go to work and return at any time to complete the Medical Office Specialist AA S degree.

Program Outcomes
At the completion of this program, the student should be able to:

• Differentiate the roles of the healthcare team, elements of successful leadership, and problem-solving strategies
• Discuss and use medical terminology
• Discuss verbal and nonverbal communication, including gender differences, cultural awareness and sensitivity, and the elements of speaking and listening
• Discuss the knowledge and skills required of a medical billing specialist/claims analyst
• Discuss the elements of billing and coding
• Complete a professional resum
• Explain job searches and correct interview techniques
• Use specialized computer programs (EMR), and the Microsoft Office suite

Medical Office students are required to have a criminal background check (http://www.mhcc.edu/docs/docsAlliedHealth/criminalbackgroundcheck.pdf), and a current Tuberculin skin test (PPD) at the beginning of the MO110 Powerful Skills for the Office Team class. Medical Office students must document completion of the three-dose Hepatitis B vaccine series and complete a Measles Immunization Clearance Certificate for School Attendance form prior to beginning the externship placement process. Some externship sites may require further immunizations. See program director for site specific requirements.

Note: A minimum grade of C is required in all courses.

1 Classes may be taken the summer prior to beginning the program.
2 Prerequisite. See course description in back of catalog.
3 Students may not use demonstrated proficiency on the College Placement Test (CPT) to satisfy this requirement.