CPB Certified Professional Biller Certification Practice Exam

What is the main function of a Health Insurance Specialist?

1. To create insurance policies for new clients

2. To prepare and review claims for accuracy

3. To provide direct patient care in hospitals

4. To manage the financial aspects of a healthcare facility

The correct answer is: To prepare and review claims for accuracy

The primary role of a Health Insurance Specialist is to prepare and review claims for accuracy. This is essential in the healthcare billing process, as it ensures that claims are submitted correctly to insurance providers and that healthcare providers are reimbursed for services rendered. This involves understanding medical coding, insurance policies, and compliance regulations to avoid denials or delays in payment. Accurate claims processing helps streamline revenue cycles for healthcare providers, as the specialist verifies that all necessary documentation is included and conforms to payer requirements. This skill set directly impacts the financial health of medical practices and facilities, making it a critical component of their operations. The other choices highlight different functions that do not align with the specific responsibilities of a Health Insurance Specialist. For instance, creating insurance policies is typically handled by insurance underwriters or agents, providing direct patient care involves clinical professionals, and managing financial aspects of a healthcare facility usually falls under the responsibilities of healthcare administrators. Thus, the focus on claim preparation and accuracy is a defining characteristic of the Health Insurance Specialist role.