Medical Billing and Coding
Incumbent medical biller is responsible for the timely submission of technical or professional medical claims to insurance companies, or directly to employer groups with direct contracts.
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.
- Credentialing and updating credentialing of insurance/third party payers when necessary
- Credentialing and updating credentialing of medical personnel when necessary
In addition to these general duties, the employer may request that you perform other duties that fit with your training and background experience or provide further training for new duties.
Education and Experience Required
- A high school diploma
- Knowledge of business and accounting processes usually obtained from an associate's degree, 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
- Familiar with use of AHIN
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.