A medical biller works in places such as hospitals, physician's offices, insurance companies, nursing homes, and outpatient care centers. The biller's primary responsibility is to process all medical billing for patient records.
Medical Billing Process
The medical billing process begins with the medical biller entering the patient's basic information, such as name, address, insurance company information and the patient's medical history, into a computer.
After the patient has visited a physician and a procedure and diagnosis determined, the medical biller will receive the patient information containing two numerical codes. These two codes stand for the level of service given and a verbal diagnosis that has been made. The medical biller's duties include checking the patient's insurance coverage and preparing and submitting the claim to the insurance company. Billers submit insurance claims either on paper via the mail or electronically.
Medical billers work with patients and insurance companies to fulfill the patient's account obligations. The insurance company will either pay the claim or reject the claim. If the claim is rejected, it must be reviewed, and the biller must resubmit the claim or the health care provider can accept an incomplete reimbursement. Negotiations over payment of a claim can occur between the health care provider and the insurance company until the claim is paid in full.
The medical biller is then responsible for collecting, processing and posting any accounts receivables and managing the patient's account. Accounts receivables include any payments from insurance companies and payments made by the patient.
Medical billers evaluate the patient's financial ability to pay any outstanding amounts not reimbursed by the insurance company and establish any payment plan necessary. Billers will also collect on any amounts past due and resolve any issues pending with any accounts. If an account is overdue, the biller may have the responsibility of placing calls to the patient for collection.
Other job functions of a medical biller include answering any questions that patients or insurance companies may have and resolving any matters or complaints.
In order to perform services as a medical biller, the biller should have sufficient training in medical bookkeeping, medical billing and coding, medical law, basic insurance, and procedural terms. The medical biller must also be familiar with all of the plans that insurance companies carry, including all fee schedules.
Knowledge of computers, medical practice management software, basic office equipment and multiphone lines are essential. The ability to complete basic office procedures and provide quality customer service are also important functions of a medical biller.
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