A medical biller is responsible for submitting medical claims to insurance companies and payers such as Medicare and Medicaid.
It is a position that is critical for the financial cycle of all health care providers, from single-provider practices through large medical centers.
Medical Biller Job Description
A medical biller is responsible for the timely submission of technical or professional medical claims to insurance companies. Medical billing requires attention to detail and experience with the electronic and paper systems used in billing healthcare services.
Job Duties for Medical Biller
· Obtaining referrals and pre-authorizations as required for procedures.
· Checking eligibility and benefits verification for treatments, hospitalizations, and procedures.
· Reviewing patient bills for accuracy and completeness and obtaining any missing information.
· Preparing, reviewing, and transmitting claims using billing software, including electronic and paper claim processing.
· Following up on unpaid claims within standard billing cycle timeframe.
· Checking each insurance payment for accuracy and compliance with contract discount.
· Calling insurance companies regarding any discrepancy in payments if necessary
· Identifying and billing secondary or tertiary insurances.
· Reviewing accounts for insurance of patient follow-up.
· Researching and appealing denied claims.
· Answering all patient or insurance telephone inquiries pertaining to assigned accounts.
· Setting up patient payment plans and work collection accounts.
· Updating billing software with rate changes.
· Updating cash spreadsheets and running collection reports.
Education and Experience Required
Basic requirements include:
· Graduate with a knowledge of business and accounting processes usually obtained from an reputed educational institution, with a degree in Business Administration, Accounting, or Health Care Administration preferred.
· A minimum of one to three years of experience in a medical office setting.
Knowledge, Skills, and Abilities
Proficiency in the following areas is preferred:
· Knowledge of insurance guidelines including HMO/PPO, Medicare, Medicaid, and other payer requirements and systems.
· Competent use of computer systems, software, and 10 key calculators.
· Familiarity with CPT and ICD-10 Coding.
· Effective communication abilities for phone contacts with insurance payers to resolve issues.
· Customer service skills for interacting with patients regarding medical claims and payments, including communicating with patients and family members of diverse ages and backgrounds.
· Ability to work well in a team environment. Being able to triage priorities, delegate tasks if needed, and handle conflict in a reasonable fashion.
· Problem-solving skills to research and resolve discrepancies, denials, appeals, collections.
· A calm manner and patience working with either patients or insurers during this process.
· Knowledge of accounting and bookkeeping procedures.
· Knowledge of medical terminology likely to be encountered in medical claims.
· Maintaining patient confidentiality as per the Health Insurance Portability and Accountability Act of 1996 (HIPAA).
· Ability to multitask.