Although there are many different career paths you can choose in the area of healthcare, this chapter refers to the domain of medical expertise of a “health insurance professional,” sometimes referred to as a medical insurance specialist. The administrative health insurance professional plays a crucial role in healthcare and one that is increasingly in demand. Qualified health insurance professionals (also referred to as medical billing and coding specialists) are experts in generating, submitting, and tracking insurance claims for a variety of payers and ensure that insurance companies reimburse the healthcare provider (and/or patient) appropriately and in a timely manner for services rendered. Those trained as health insurance professionals are vital not only to healthcare providers but to health insurance companies as well. They also play an important role in patient advocacy. Although job opportunities in this career field are increasing because of the relatively complex nature of health insurance in general (particularly the coding process), the industry is placing great emphasis on training and experience. Certification is recommended and is available for various specialties in the allied health field. Certification tells prospective employers that the individual possesses the skills necessary in a particular area, which helps the office run efficiently and effectively and provides for each patient’s specific needs. (See “Certification Possibilities” later.)

It should be noted here that although we refer to this career field as “health insurance professional,” there is no nationally recognized title or acronym for this broad specialty.