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What is Medical Billing?

what is medical billing

More than likely you have landed on this page looking for answer to the question, “what is medical billing?” Even though some people do lump medical billing and coding together as one job. While these two jobs do work closely with each other there are vast differences between their roles and responsibilities. In this article we will spend some time going over the medical billing job description so that you will have a better understanding.

What is Medical Billing?

Medical billing is one of the more important positions in a functioning and successful healthcare facility. They are tasked with being responsible for gathering payments for all of the services provided to patients. A good medical biller will be cherished by all employees of a healthcare facility since the biller’s success means they get paid.

Medical Biller Job Description

Below are some of the most common duties that are performed daily by medical billing team members. While there may be other responsibilities given out at a specific healthcare facility the ones listed below are part of a typical medical billing job description.

Data Entry

what is medical billingAs a medical biller, you will spend most of your time decoding and entering alphanumeric in to special billing software. This information is then used to create a billing invoice for patients and insurance companies.

Billing Claims

After the information has been decoded and entered in to the billing software, the medical billing team will produce an invoice to submit to insurance companies. This billing claim will have the patient’s name, insurance ID number and all of the procedures received by the patient along with the fees associated with the procedures. If it is a patient without insurance, also called an out-of-pocket or cash patient, then the billing invoice will be given to the patient directly.

Processing Claims

The next step of the process is recording the insurance company’s reply to the billing invoice. After receiving the billing claim the insurance companies may deny, accept or only partially pay the claim. The biller will update the patient’s records from the information given to them by the insurance company.

Another part of processing claims, the medical biller will contact the patient via mail with an invoice. This billing claim will explain to the patient which of the services has and hasn’t been paid by the insurance company and what is currently owed.

Bill Collections

medical billerAn important aspect of the medical biller’s job is to track and collect on all outstanding payments. This can be done with friendly reminders in the mail, contacting the patient or insurance company by phone to either get payment or set up a payment system. If the outstanding debt is terribly in arrears, the medical biller could use a collection agency to collect on the debt.

All Other Duties

  • Keeping up with changing healthcare and insurance regulations
  • Providing any extra information to insurance companies or government agencies pertaining to billing claims
  • Answer questions from patients concerning their medical billing invoices
  • Always being professional and courteous when dealing with people
  • Have in-depth knowledge of procedures and processes of insurance companies, Medicare, Medicaid and Social Security
  • Be familiar with privacy laws, patient rights and rules and regulations concerning debt collection
  • Well versed in medical terminology, medical codes and medical databases
  • Back up all computer files and payment history for safe keeping
  • Respond to all requests made by insurance companies and other healthcare related professionals

Important Note

Since medical billers have access to patient records and financial information they must stay in compliance with local and federal regulations concerning patient rights and privacy. Due to all of the privacy regulations, most medical billers work in an office environment and very few can work from home. According to the US Bureau of Labor Statistics, roughly 2% of medical billing specialist work from home.

You may be surprised to learn that those looking to become a medical billing specialist can do some from the privacy of their home through online classes and what is even more impressive is that it is possible for you to work from home too. Now that you have a better understanding of what is medical billing so that you can make the informed decision to enroll in training today.

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