Standard Occupational Classification (SOC): Miscellaneous Financial Clerks

Miscellaneous Financial Clerks in Healthcare include individuals who perform a variety of financial and administrative tasks in a healthcare setting, such as hospitals, clinics, and nursing homes. These workers may include billing and coding specialists, insurance claims processors, and healthcare reimbursement analysts, among others. They are responsible for maintaining financial records, submitting insurance claims, and ensuring that reimbursement is received for services rendered.

Billing and Coding Specialists are responsible for maintaining accurate and up-to-date records of all medical procedures and services performed, using standardized codes to describe the services. They then use this information to generate bills and submit them to insurance companies for reimbursement.

Insurance Claims Processors are responsible for reviewing claims submitted by healthcare providers and ensuring that they meet the requirements set forth by insurance companies. They review claims to ensure they are complete, accurate, and comply with the insurance company’s guidelines. They also review claims for any errors, omissions or duplicates, and work with providers to correct any discrepancies.

Healthcare Reimbursement Analysts are responsible for analyzing healthcare reimbursement data and recommending strategies for maximizing reimbursement from insurance companies and other payers. They may also be responsible for negotiating contracts with insurance companies and other payers, and for developing reimbursement policies and procedures for healthcare providers.

Overall, They must be knowledgeable of medical terminology and the process of billing and insurance claims, they should be able to identify the codes and procedures that will be used to bill insurance companies, and they should be familiar with the policies and regulations that apply to healthcare billing and reimbursement.