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Reimbursement specialist skills for your resume and career

Updated January 8, 2025
5 min read
Reimbursement specialist example skills
Below we've compiled a list of the most critical reimbursement specialist skills. We ranked the top skills for reimbursement specialists based on the percentage of resumes they appeared on. For example, 20.1% of reimbursement specialist resumes contained patients as a skill. Continue reading to find out what skills a reimbursement specialist needs to be successful in the workplace.

15 reimbursement specialist skills for your resume and career

1. Patients

Here's how reimbursement specialists use patients:
  • Perform mathematical calculations for submitting insurance claims including deductible amounts, allowed amounts, secondary insurance allowed amounts and patients responsibility.
  • Communicated effectively with patients providing explanations of balance due, patient responsibility and collection efforts to reduce outstanding accounts receivable.

2. Customer Service

Customer service is the process of offering assistance to all the current and potential customers -- answering questions, fixing problems, and providing excellent service. The main goal of customer service is to build a strong relationship with the customers so that they keep coming back for more business.

Here's how reimbursement specialists use customer service:
  • Facilitated in depth training of 30 customer service representatives that proactively resolved reimbursement escalations resulting in reduced time spent addressing inquiries.
  • Deliver excellent customer service via telephone and fax as well as email for quantitative analysis of company valuations and financial modeling.

3. Appeals

Here's how reimbursement specialists use appeals:
  • Resolved errors by resubmitting corrected or unacknowledged claims, medical records, appeals and other documentation required for timely payments.
  • Processed written appeals and telephone appeals with supporting documentation to various insurance companies and government payers.

4. CPT

CPT is a medical term that stands for Current Procedural Terminology. Whenever a procedure like surgery or diagnosis occurs or some other medical service is rendered to a patient, it is reported to the concerned physician, insurance company, or organization. The aforementioned practice is widely referred to as CPT.

Here's how reimbursement specialists use cpt:
  • Reconciled charges, daily coding audits and reimbursement analysis, coordination of master-file updates, fiscal year ICD-9 and CPT code updates
  • Review claims to ensure the correct ICD-9 and CPT codes were reported to the insurance carrier and claims were paid correctly.

5. Medicare

Medicare is a federal government insurance program that offers health care coverage to people who are 65 and above. In some cases, younger people with disabilities whose status is identified by the SSA can also avail the insurance program. Medicare covers the health expenses of people who are not able to afford it plus it protects the payee from rising health care costs.

Here's how reimbursement specialists use medicare:
  • Prepared financial models to estimate effect of changes in Medicare reimbursement methodologies on revenues for HealthSouth hospitals.
  • Streamlined process of preparing Medicare bad debt documentation for annual cost report by automating data collection efforts.

6. Medicaid

Here's how reimbursement specialists use medicaid:
  • Used knowledge about prior authorization processes for private insurance carriers and state Medicaid programs to ensure that beneficiaries received eligible coverage.
  • Obtain reimbursement follow-up information and initiates certified medical necessity letters for third party authorizations and Medicaid prior authorizations as appropriate.

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7. Medical Terminology

Here's how reimbursement specialists use medical terminology:
  • Interpret medical terminology and pharmacological information for translation into the coding system.
  • Experienced in medical terminology, accounts receivable, insurance collections or billing.

8. HCPCS

Here's how reimbursement specialists use hcpcs:
  • Reviewed ICD-9/ ICD-10 and HCPCS codes to clinically qualify patients under Medicare Part B guidelines.
  • Facilitate prior authorization process within the program identifying ICD-9 and HCPCS coding requirements.

9. Patient Accounts

Patient accounts are a part of a hospital information system that is used for storing financial data, keeping a record of healthcare costs, and providing information regarding patient billing. It deals with the financial aspects of the healthcare setting.

Here's how reimbursement specialists use patient accounts:
  • Maximize collection of patient accounts through telephone contact, written inquiries and or appeals to facilitate appropriated reimbursement.
  • Document patient accounts in computer system with insurance information and collection activity according to EBO standards.

10. HIPAA

Here's how reimbursement specialists use hipaa:
  • Protected patient information and company assets by understanding and practicing HIPAA privacy rules while executing all patient related transactions.
  • Remained updated on changes and additions to HIPAA guidelines by participating in annual regulatory training.

11. Home Health

Here's how reimbursement specialists use home health:
  • Prepare and analyze Medicare cost reports for hospitals, skilled nursing facilities, home health agencies, and rehabilitation agencies.
  • Assisted with processing payroll for Adventist Home Assistance, Adventist Preferred Nursing, Adventist Choice Nursing and Adventist Home Health.

12. Medical Billing

Here's how reimbursement specialists use medical billing:
  • Perform medical reimbursement billing/collections for a Pharmaceutical facility and understanding the concepts of medical billing, policies and procedures.
  • Managed and coordinated clinic operations related to registration, medical billing, and claim submission.

13. Data Entry

Data entry means entering data into a company's system with the help of a keyboard. A person responsible for entering data may also be asked to verify the authenticity of the data being entered. A person doing data entry must pay great attention to tiny details.

Here's how reimbursement specialists use data entry:
  • Verify prescriptions, eligibility, benefits and initial data entry of information based on established policies and procedures.
  • Handled inbound/outbound reimbursement and patient assistance program calls while performing benefit investigation and data entry.

14. EOB

EOB stands for explanation of benefits. This is a common outline provided as part of many health insurance plans to explain what services were completed, the co-pay required for each appointment, and how much of your payment is covered by health insurance. EOB is an indication that your insurance claim has already been processed.

Here's how reimbursement specialists use eob:
  • Deposit processor: Tear live checks apart from EOB'S, add EOB'S and checks separate to match total.
  • Filed level II-III appeal(s) based incorrect payments, EOB rejections, and other issues with accounts.

15. CMS

A Content Management System or CMS is computer software that works as a framework where content can be assembled and managed by using a database. CMS is an important asset in web development. This platform enables users to create, edit, collaborate on, publish and store digital content. It helps users to manage their content and modify it from a single system.

Here's how reimbursement specialists use cms:
  • Identified and resolved issues with Outcome and Assessment Information Set (OASIS) data prior to CMS (Medicare) submission.
  • Analyzed & reviewed CMS 1500 claim forms for all errors; corrected forms as needed and resubmitted claims for payment.
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List of reimbursement specialist skills to add to your resume

Reimbursement specialist skills

The most important skills for a reimbursement specialist resume and required skills for a reimbursement specialist to have include:

  • Patients
  • Customer Service
  • Appeals
  • CPT
  • Medicare
  • Medicaid
  • Medical Terminology
  • HCPCS
  • Patient Accounts
  • HIPAA
  • Home Health
  • Medical Billing
  • Data Entry
  • EOB
  • CMS
  • Insurance Benefits
  • ICD-9
  • Insurance Carriers
  • Insurance Claims
  • Insurance Verification
  • Insurance Coverage
  • Billing System
  • Patient Demographics
  • Unpaid Claims
  • Credit Balances
  • MDS
  • Account Balances
  • Fee Schedules
  • Billing Issues
  • Hippa
  • Medical Claims
  • Billing Process
  • Medical Necessity
  • Accounts Receivables
  • Outbound Calls
  • Benefit Investigations
  • Reimbursement Issues
  • Durable Medical Equipment
  • HMO
  • Medical Documentation
  • Patient Eligibility
  • Unpaid Accounts
  • Financial Assistance
  • Delinquent Accounts
  • Private Insurance
  • Electronic Claims
  • Clean Claims
  • PPO
  • Electronic Billing
  • Process Claims

Updated January 8, 2025

Zippia Research Team
Zippia Team

Editorial Staff

The Zippia Research Team has spent countless hours reviewing resumes, job postings, and government data to determine what goes into getting a job in each phase of life. Professional writers and data scientists comprise the Zippia Research Team.

Updated January 8, 2025

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