Hard Skills
IntermediateMedical and Dental TerminologyA foundational understanding of clinical terms, anatomy, and healthcare procedures required to interpret provider bills and patient records.
AdvancedHIPAA ComplianceStrict adherence to the Health Insurance Portability and Accountability Act standards for protecting the privacy and security of health information.
AdvancedClaims AdjudicationThe process of reviewing and determining the insurer's liability for a claim based on the terms of the insurance policy and plan design.
IntermediateCDT and CPT CodingProficiency in Current Dental Terminology (CDT) and Current Procedural Terminology (CPT) codes used for reporting healthcare and dental services.
AdvancedFraud, Waste, and Abuse (FWA) DetectionThe ability to identify suspicious billing patterns, over-utilization of services, or falsified documentation in insurance claims.
IntermediatePolicy InterpretationThe skill of reading and applying complex legal language found in Summary Plan Descriptions (SPDs) and insurance contracts.
IntermediateCoordination of Benefits (COB)The process of determining which insurance plan has the primary payment responsibility when a patient is covered by more than one plan.