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A Day in the Life of a Medical Biller

Apr 08, 2010

Before you consider a career as a medical biller, you may want to find out just what the job entails. While medical billing is not the most exciting job out there, it does offer regular employment, a good salary, and requires little training. Many people become medical billers straight out of high school, while others choose to take courses to become Certified Medical Reimbursement Specialists.

How does medical billing work? It all starts with a patient meeting with their health care provider, which could be a doctor, dentist, or other type of medical professional. The patient’s medical record will house all of their information – including all the billing information for their insurance provider. When the health care provider meets with the patient, they will record all relevant information regarding the purpose of the visit, diagnosis, tests, medications, and treatment. All this information is then used for medical billing.

Each type of treatment, test, diagnosis, etc., is assigned a code by the medical biller. These codes are used to indicate the payment and other details, which is then transmitted electronically or manually to the insurance provider. Medical billers are generally trained, or take courses on the methodology of submitting claims.

The insurance company will review each claim as it comes through. Claims that are approved will be sent back with payment, and claims that are rejected will be sent back with notations explaining why no payment was forwarded. The medical biller will reconcile all of the payments with the patient records and close those claims, and then sort out the rejected claims, correct them, and send them back to the insurance company for approval. This may take several attempts as the coding process is quite complicated.

Many insurance companies, particularly state-funded Medicaid, still use a manual billing process, which means there can be significant delays between the when a claim is submitted to the time payment is forwarded. As a medical biller you need to process these claims as quickly as possible to avoid any further delays, as this can affect a patient’s standard of care. Additionally you will have to have detailed knowledge of what each insurance company covers, and what their negotiated rate with the health care provider is.

As more insurance companies allow for electronic claims submission, you will increasingly be working in an entirely computerized environment. However, each insurance company may use different software, so you need to be able to learn new programs and use them efficiently. Additionally you need to have a good attention to detail so you can correctly code each claim to ensure that payment is approved, and be willing to keep up with the latest changes in medical billing.

Depending on where you work you may have other roles besides medical billing. If you work in a small office you may also be an office administrator or receptionist, as this allows your employer to reduce costs. If you work for a hospital or independent contractor you may do only medical billing, and if it is a very large company you may have only one or two tasks. Medical billing is fast-paced and can be a bit stressful at times, so it is important to always do your best to avoid billing issues that result in delayed payment.

If you can see yourself working at a computer for long periods of time, and like using the latest technology then you will probably do well as a medical biller. Jobs in this area are growing so many employers will need new medical billers. Start by finding out how you can be qualified for a medical billing job in your area.

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