Medical billers are very much in demand in today’s modern world. The health care industry in the United States is full of complexities.
A medical biller is responsible for making sure that insurance claims are filed and reimbursed properly, that health care professionals are paid, and that any discrepancies in payment plans are sorted out.
Medical billers help to bridge the gap between insurance companies, patients, and health care providers. They navigate the complex workings of insurance claims and policies. The job provides a fast-paced career and a strong amount of self-direction, while also allowing you to interact with multiple other individuals on a day-to-day basis.
Working for an insurance company will be slightly different from working for a health care provider. Rather than working on claims for many different insurance companies, you’ll be processing claims for many different doctors and health care professionals.
What Is a Medical Biller?
A medical biller is an expert in the field of claims processing for medical treatment. There are many different areas with which you’ll need to become familiar. Different workplaces will have different day-to-day requirements and types of work.
Medical billers often work as medical coders simultaneously. However, this isn’t always the case. When you work as a medical biller, you’re unlikely to need to transcribe procedures into code. However, you will need to interpret procedures that another specialist has encoded and sent to the insurance company.
The Importance of Understanding Medical Coding
Whenever patients have an appointment with any kind of medical professional, the examinations and procedures they undergo will need to be billed. To make the billing process more efficient, different aspects of health care are transcribed into code. These codes are used to make calculations regarding insurance claims and policies.
A medical biller must be familiar with these codes. If you’re working for an insurance company, you will need to interpret the coded claims you receive. You may need to determine what procedures are covered by a patient’s insurance policy, if any. You will also need to determine what kind of compensation the medical professionals are receiving.
Typical Duties of a Medical Biller
The role you play will vary slightly depending on the setting you work in. Working for an insurance company will be different from working in a health care setting. With that said, most billers have the same basic duties in any health care setting, regardless of whether it’s a clinic or a physician’s office.
When working in a health care setting, you’ll use your knowledge of coding procedures to create coded bills for insurance companies and patients. When working for insurance companies, you’ll use that same knowledge to interpret the insurance bills sent to you by other medical billers. In addition to documenting and interpreting patient treatments, you’ll also document patient diagnoses and other important information regarding patient appointments.
As a medical biller, you can expect to be involved in these duties.
- Analyzing and reading patient records
- Determining how to code the treatments and diagnoses outlined in patient records
- Double-checking the codes used by other billers against patient records to make sure they’re accurate
- Filing insurance claims and billing providers based on codes
- Following up with physicians, nurses, receptionists, and other assistants to make sure the records are accurate
- Tracking and storing patient data over the course of multiple visits
- Managing highly detailed information
- Navigating and using specialized coding software to streamline the process and increase efficiency
- Maintaining information security, patient confidentiality, and HIPAA compliance
No matter what environment you work in, you’re likely to be removed from the area where patient care takes place. If you work in a health care setting, you’ll probably have an office that’s removed from the patients. You may need to go to the areas of patient care to follow up with doctors and assistants.
When you’re working for an insurance company, you’ll most likely have an office setting. The exact setup will vary from case to case.
What Is Working as a Medical Biller for an Insurance Company Like?
When you work as a medical biller for an insurance company, you use your skills in a different way than at a traditional health care facility. However, you can use your medical billing knowledge to become a claims specialist for an insurance company. This job will have slightly different duties and allow you to stretch the limits of your knowledge.
Claims specialists, also called claims investigators and claims examiners, are the individuals responsible for reviewing the insurance claims from clients. They will determine whether the encoded information is covered under the client’s insurance policy. They also evaluate how much the insurance company is required to pay based on the policy’s language.
Typical Job Duties at a Health Insurance Company
When you’re working as a medical claims specialist for an insurance company, it’s important to understand the duties you’ll be expected to perform.
- Reviewing submitted insurance claims to make sure all filing procedures have been properly followed
- Assisting insurance adjusters with the completion of unusual or complicated claims
- Making sure the costs of patient treatment are reasonable depending on the diagnosis
- Determining whether to approve, deny, or forward claims to investigators for ongoing review
- Examining unusual and complex claims to determine if they’re covered or not
- Authorizing the payment of claims
- Setting reserves on the payment of claims
- Ensuring that funds are disbursed to clients in a timely manner
- Conducting or coordinating investigations on unusual claims
- Identifying claims that allow potential recovery from third parties
- Consulting with doctors, other medical professionals, insurance agents, and attorneys regarding the disposition of complicated claims
If you’re trained as a medical biller, you will have unique insight into the way that medical claims are encoded and processed. This will make it easier for you to navigate and untangle complex claims, as well as to communicate with health professionals for clarity where need be.
Skills Needed for Success as a Medical Biller
There are a number of skills that are important in your career as a medical biller. You’ll need to have an analytical approach to problem solving.
As an expert in your field, it’s important that you know how to recognize and respond to problems. You need to be self-reliant and an individual who other people can rely upon. When you need to communicate with others, you’ll need to be clear and direct.
Attention to Detail
A medical insurance biller needs to have strong attention to detail. Every aspect of the job involves complex focus.
Though mistakes are often easily rectified, you don’t want to go through the hassle of rebilling or reprocessing an insurance claim. Plus, mistakes have the potential to be costly and cause headaches for everyone involved.
You need to understand the coding procedures that are used for different insurance claims and how to interpret and read them. Even if your duties don’t involve turning patient records into coded claims, you’ll need to know what every coded claim means. When there are discrepancies, you’ll need to compare the coded claim to the original patient records to be sure there aren’t mistakes.
If you work for an insurance company, you’ll also need to pay attention to the details of different policies. The language of a policy will illustrate specifically what is and isn’t covered. You’ll have to understand how to read policies and make claims calculations based on the given information.
Communication is a vital skill. Though the majority of the job is self-directed, you will need to speak to different people to follow up on information. When you’re working as a medical insurance biller, you can expect to regularly interact with these people.
- Physicians, nurses, assistants, and other health care professionals
- Insurance investigators
- Other claims specialists
- Anyone else involved in the billing process
It’s vital that you stay organized in your duties. When you’re working with medical information, there will be strict regulations for you to follow regarding patient confidentiality. You’ll need to comply with HIPAA guidelines and standards for patient privacy.
Being organized is also important because it helps with efficiency and accuracy. If your workplace is scattered, you’ll have trouble finding the information you need.
The majority of motivation for a medical insurance biller is self-directed. You should have a strong internal sense of discipline and reward. You’ll have a lot of freedom to do the job how you want, as long as you get things done efficiently.
A medical biller is best known for working for health care providers, encoding information so it can be sent to insurance companies. However, you can also use your skill sets and knowledge to work as a claims specialist for an insurance company instead.
When you work for an insurance company, you’ll be doing a lot of policy investigating and determining how much of a bill a policy covers. You’ll also be following up on claims and talking to medical professionals to get clarification where need be.
If you like self-directed problem solving, engaging and fast-paced day-to-day work, and organization, this may be just the career for you.
Did learning about how to become a medical biller for an insurance company and the duties that are assigned interest you? Are you ready for a rewarding career as a medical biller?
The Medical Billing Specialist program at Hunter Business School on Long Island prepares billing students to obtain entry-level employment specializing in medical related billing in physicians’ offices, clinics, and medical insurance companies. The Medical Billing Specialist program is a three-month diploma program available in the evening.