Medical Biller job description

A Medical Biller is a vital component of healthcare administration responsible for processing medical claims and ensuring timely payment from insurance companies. They play a crucial role in the medical billing cycle by accurately translating medical procedures and services into codes that can be properly billed and reimbursed by insurance providers. Medical Billers are typically employed in hospitals, clinics, and healthcare facilities, but they can also work remotely for billing companies or insurance agencies.

As a Medical Biller, you will be responsible for the following:

• Reviewing patient medical records to identify medical procedures and services provided
• Assigning appropriate medical codes (e.g., ICD-10, CPT) to documented procedures and services
• Preparing and submitting medical claims to insurance companies electronically or via paper format
• Ensuring accurate and complete documentation of medical claims, including patient demographics and insurance information
• Following up on unpaid or rejected claims and resolving any billing discrepancies
• Communicating with insurance companies, healthcare providers, and patients regarding claim status and payment issues
• Monitoring and reconciling insurance payments to ensure accurate reimbursement
• Identifying and appealing denied or underpaid claims to maximize reimbursement
• Maintaining up-to-date knowledge of medical billing regulations and coding changes
• Ensuring compliance with HIPAA regulations and patient confidentiality

In order to be considered for the role of a Medical Biller, candidates must meet the following minimum requirements:

• A high school diploma or equivalent
• Proven experience in medical billing or a related field
• Familiarity with medical coding systems (e.g., ICD-10, CPT)
• Proficiency in using medical billing software and electronic health record (EHR) systems
• Strong knowledge of medical terminology and procedures
• Excellent attention to detail and accuracy
• Strong analytical and problem-solving skills
• Ability to work independently and meet deadlines
• Effective communication and interpersonal skills
• Ability to maintain strict confidentiality of patient information

To be eligible for the role of a Medical Biller, candidates must possess the following minimum qualifications:

• Associate’s degree in Medical Billing or a related field OR certification in Medical Billing and Coding
• Demonstrated knowledge of medical billing procedures, insurance claim processing, and reimbursement methods
• Proficiency in using billing software such as CMS-1500 and electronic data interchange (EDI) systems
• Understanding of health insurance plans, including Medicare, Medicaid, and private insurance
• Experience with government programs and regulations related to medical billing, such as HIPAA and Stark Law
• Ability to interpret and apply coding guidelines, including CPT, HCPCS, and ICD-10 codes
• Understanding of medical billing audits and compliance
• Knowledge of medical billing reports and data analysis
• Strong computer skills, including proficiency in Microsoft Office
• Ability to adapt to changes in the healthcare industry and stay updated on coding and billing changes

While not mandatory, the following skills and qualifications are highly recommended for Medical Billers:

• Bachelor’s degree in Health Information Management, Business Administration, or a related field
• Certification as a Certified Professional Coder (CPC) or Certified Coding Specialist (CCS)
• Experience with electronic health record (EHR) systems and healthcare practice management software
• Knowledge of medical insurance and claims processing software, such as EPIC or Medisoft
• Experience in dealing with denied claims and insurance appeals
• Proficiency in medical billing software, such as Kareo, AdvancedMD, or AthenaCollector
• Strong knowledge of specific medical specialties, such as radiology, orthopedics, or cardiology
• Experience with coding certifications, such as Hierarchical Condition Category (HCC) coding
• Understanding of revenue cycle management and financial reporting
• Ability to train and educate staff on medical billing processes and coding guidelines

A Medical Biller plays a vital role in ensuring accurate and timely reimbursement for medical services provided. By accurately coding medical procedures, submitting claims, and following up on payments, Medical Billers contribute to the financial stability of healthcare organizations. To excel in this role, candidates must possess strong knowledge of medical billing procedures, coding systems, and insurance claim processing. They should also be detail-oriented, possess excellent analytical and problem-solving skills, and have the ability to work independently while meeting deadlines. Additional qualifications, such as a degree in Medical Billing, coding certifications, and proficiency in medical billing software, can enhance a candidate’s prospects in this field.