Elements for a Medical Billing Clerk or Specialist
A medical biller is responsible for submitting medical claims to insurance companies and payers such as Medicare and Medicaid. It is a position that is critical for the financial cycle of all health care providers, from single-provider practices through large medical centers. It requires attention to detail and experience with the electronic and paper systems used in medical billing.
If you are interested in medical billing as a career, you can explore the elements often found in a job description for the position below. If you are updating or writing a job description for the position, you can use the elements below and modify them as is appropriate for your facility. You may also be interested in learning about the expected salary as well as employment outlook for a medical biller.
Medical Biller Job Description
In essence, a medical biller is responsible for the timely submission of technical or professional medical claims to insurance companies. The position may be located in physician offices, hospitals, nursing homes, or other healthcare facilities.
Job Duties for Medical Biller
What does a medical biller do day to day on the job? The specific duties, as well as the amount of time you would spend on these, will vary from one setting to another. That said, your occupational duties may include:
- 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
In addition to these general duties, an individual 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
The amount of education and experience an employer requires will vary depending on the complexity of the job and need. A minimum work experience is often preferred, but everyone needs to begin somewhere. Don’t let a minimum number of years of job experience deter you if you feel you have been properly trained to fulfill all potential duties at a particular job.
Basic requirements most often listed include:
- 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.
A potential employer will want to see you demonstrate knowledge, skills, and abilities in a number of areas. You will likely be asked about these in an interview, and your potential employer will ask what skills you’ve used in any previous jobs as a medical biller.
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.
Expected Salary for Medical Biller
The median salary for medical biller was $33,217 in 2017, with a range of roughly 25,000 to 44,000 depending on individual performance, years of experience, education, and job location. The salary can also vary by setting, whether a small individual practice, a group practice, nursing home or a larger medical center. This translates to an hourly rate ranging from $11.70 to $20.26 per hour. Some jobs also offer bonuses or profit sharing.
Outlook for Jobs as a Medical Biller
The outlook for employment as a medical biller is very good, with demand expected to increase 21 percent from 2017 to 2020.