Claim-Assistant Professional, Your Ticket to Fighting Fraud
by Debbie WilsonDebbie.Wilson@MedicalHealthCareCareerSchools.com
Medical Healthcare Career Schools Columnist
According to the National Association of Insurance Commissioners, approximately 85 percent of hospital bills contain errors. With such billing mistakes all too common, you can't afford not to review your claims with a fine-tooth comb. Alas, enter the cavalry: claim-assistance professionals. Find out how you can join this lucrative career and become a claim-assistant professional, too.
What Is a Claim-Assistance Professional?
A claim-assistance professional, or CAP as they are commonly referred to, is a relatively new type of consumer advocate. They specialize in helping patients manage billing problems and resolve disputes. More and more jobs and positions are being created to help the consumer with these billing errors and insurance scams.
Claim-Assistance Duties
As a claim-assistance professional, your main duties will center on sorting through medical bills, identifying errors, and negotiating discounts. Additionally, you'll help your clients with preventive measures to ensure that they can "stop the bleeding." For instance, when selecting an insurance carrier, you'll help them choose a policy as if they were a sick person. Consider what out-of-pocket costs would be if they became seriously ill, what exclusions the policy has, and cost caps on expensive treatments and procedures. Finally, stress the importance of getting proper authorization before undergoing treatment and obtaining second opinions if necessary.Why a Career as a Claim-Assistance Professional Makes Sense
Many companies simply ignore routine patient billing inquiries. But as a claim-assistance professional, you can do so much more than simply gather the necessary paperwork or authorizations. Most companies will honor requests for a 30-day extension, which can give you time to sort out billing problems. And since today's computerized billing programs offer little grace periods, this can be a critical benefit. Additionally, as a claim-assistance professional, you might demand the attention of claims processors and insurers more directly, be privy to state laws and resources, and even specialize in particular health insurers.So go ahead and join the cavalry as a claim-assistance professional. Your advice just might help the average insured from medical sticker shock and allow them to obtain the care they deserve and truly need.
About the Author
Debbie Wilson operates a lakeside resort. Her previous experience includes profitability consulting for a national health-care company. Debbie holds a B.A. in Business Management with a minor in Physical Education.
Posted on: June 16, 2006
