I Need Help with Life Changing Decision

[redspot321]

I wouldn't be losing any benefits as I will be transitioning from a bedside/ supervisor role to a office team leader number cruncher role. It's the same organization very well respected health care and health plan company rated in the top 5% of everything they do. Even though don't plan on selling insurance I still need to have a good understanding of the profession to operate at the financial level.

The company is health first health plans. In brevard county Florida. Trust me not to insult. Anyone here but I really have no intest in sales but need to have a good understanding of what's going on

 

[Ann H]

It seems to me that you have your hands full. You'll need a good education on several issues in order to comply with this job's requirements. It sounds like it would be important for you to understand insurance sales in order to be a team leader in that department. One of the best ways to do that is to sell to yourself. For instance, if you don't know the difference between a PPO and an HMO, take your own personal situation as a model, and search for insurance for yourself. Since you have a chronic medical condition, you would be keenly interested in the benefits and restrictions of each type of plan. Search for a plan for yourself, ask questions, get to know the differences. Then, sell to your mother and father (in concept if not in reality). Get to know the market for them. Perhaps they are still in the under-age-65 market, or perhaps they are in the medicare market. Research, and make choices about what's best for them. When questions and objections come up, and when you think perhaps you or your parents would be harmed by a certain choice, get on this forum and research what agents have said about that very issue that you think is suspect. The best way to research is to make it personal. You'll uncover the "holes and the dangers", and you'll remember the issues much more clearly.

Next, it appears that you need some other education. You said that the job required:

" knowledge of medical benefits, provider reimbursement methodologies, medical and dental terminology, knowledge of claim adjudication and benefit plan application for Point of Service, HMO or Medicare plans. knowledge of Medicare/Medicaid/Medigap coverage/guidelines and Commercial HMO/Health Insurance contracts. knowledge of CPT, ICD-9 and HCPCS coding system." "Knowledge and understanding of Federal Medicare program, Medicare Advantage Plans, and the medical insurance industry in general. PAHM or other health care related certification "

Let's break this down. It appears that they want you to understand health plans, and about claims.

This part is about health plans - knowledge of medical benefits, provider reimbursement methodologies, medical and dental terminology,.... knowledge of Medicare/Medicaid/Medigap coverage/guidelines and Commercial HMO/Health Insurance contracts.... "Knowledge and understanding of Federal Medicare program, Medicare Advantage Plans, and the medical insurance industry in general.

This part is about claims - knowledge of claim adjudication and benefit plan application for Point of Service, HMO or Medicare plans.... knowledge of CPT, ICD-9 and HCPCS coding system."

The knowledge about claims and coding can't be done by researching for yourself. You might look into some classes for this. Lots of schools offer 8 week classes to train people to become medical billing coders for claims.

Good luck. When I got my first job in the insurance industry, I had just finished college after studying journalism. I didn't know what a premium was. The first day on the job, they gave me an actual policy to read to educate myself!!!!! I survived, thankfully! There are other ways to research.