Certified Medical Software/Insurance/Pre-authorization Specialist
BECOME A MEDICAL SOFTWARE INSURANCE/PREAUTHORIZATION Specialist

Overview

Medical Software, Insurance and Pre-authorization Specialist work in physicians’ offices, hospital, urgent care center, billing companies, insurance companies and many more places. Their main duty is to input data into the Medical Billing Software to process the claims for reimbursements. Moreover, they must have an understanding on various types of insurances and the procedures to billing for the services rendered to the patient, apart from this their other main duty includes verifying insurance benefit eligibility and obtaining pre-authorization for services. 

 

Requirements

Candidates registering for the exam must qualify in (at-least 1) of the GROUPS (A or B or C) as shown below. Training and experience may be completed within united states of america or outside united states of america. 

GROUP A

EDUCATION

Training or

Equivalent

(Nationally or Internationally)

GROUP b

experience

Have work experience

or

Equivalent

GROUP C

MILITARY

Must submit proof of education or experience.

Duties

  • Communication Skills (Verbal and Written)

  • Computer Skills

  • Customer Service Skills

  • Accurately Code (CPT & ICD)

  • Perform Pre-authorization

  • Check Eligibility

  • Input Data into Medical Billing Software

  • Review Patient Reports

  • Prepare Claim

  • Review Claim

  • Submit Claim Electronically

  • Check Claim Status

Skills

  • Communicate with Provider, Patient, Insurance

  • Billing Primary, Secondary of Tertiary Insurance

  • Appeal Denied Claims

  • Post Insurance Claims

  • Post Charges

  • Post Payments Received (Electronically or Manually)

  • Resolve Patient Billing Issues

  • Perform Pre-authorization for Patients

  • A/R Management

  • Collections Process

  • Other Duties as Assigned

Skills

Exam Test Plan

The exam content topic includes the following:

  1. Revenue Cycle Management

  2. Medical Billing Software

  3. Pre-Authorization

  4. Insurance (Medicare, Medicaid, Tricare, BCBS, Workers Comp)

 
 
 

Renewal

AECA believes in continuing education more frequently so that the candidate can have a constant touch with knowledge, Candidate’s are required to attend the continuing education units / credits every year to renew their certification.

Certification is required to be renewed annually.

On submitting a renewal application the candidate will receive an email with links to CEUs that must be completed and submitted online. 

Fee Schedule for Renewal

Renewal Fee: $50

Renewal: 

Certification that are expired must apply for reinstatement.

If you wish to apply to reinstate your expired certification you may proceed by submitting a reinstatement application. 

 

Fee Schedule for Reinstatement

Expired Less than 1 Year: $99  

Expired More than 1 Year but Less than 2 Years: $199

Reinstatement