Medical Biller

Medical biller is an important role in the healthcare industry as it acts as a bridge between health care providers, patients, and insurance companies. A medical biller is responsible for handling and transferring patient information, submission of claims to insurance companies, and also ensures that the payments for medical services are received in a timely manner. He is also responsible for maintaining the confidentiality of patient information and following up with the insurance providers for delays or nonpayment. 

• To ensure that all patient information is accurate and complete and request any missing patient information.
• To obtain and review referrals and authorizations for treatments.
• To confirm patient benefits and insurance eligibility.
• To follow and adhere to all regulations and guidelines set by state programs, and HMO/PPO, etc.
• To transfer insurance claims and billing data to billing software.
• To update billing software with rate changes.
• To create both paper and electronic copies of documentation.
• To develop and maintain a tracking system of incoming and late payments.
• To follow up on late payments and initiate late payment notices to relevant parties.
• To work with personal information and maintain patient confidentiality.
• To monitor and resolve financial discrepancies.
• To handle and answer all patient or insurance telephone inquiries

The basic education and experience required for being a medical biller are:

• A high school diploma.
• Completion of medical billing/coding program required
• Knowledge of business or accounting or medical office processes is preferred

Apart from having the required qualifications, there are a few skills or abilities which are required for being a medical biller. Proficiency in the following areas is generally preferred by the employer:

• Should possess excellent verbal and written communication skills.
• Should have a good knowledge of insurance guidelines as well as schemes like HMO/PPO, other payer requirements, and systems.
• Should be competent enough to use computer systems, software, and calculators.
• Must be familiar with CPT and the latest coding guidelines.
• Should possess good communication skills and must be able to handle and resolve issues of patients and insurance payers.
• Should be comfortable to be a part of the team and work in a team environment.
• Should be able to prioritize the tasks and handle multiple situations.
• Should have a problem-solving aptitude and ready to work on resolving discrepancies.
• Should have a sound knowledge of accounting and bookkeeping procedures.
• Should be able to maintain patient confidentiality as per the HIPAA (Health Insurance Portability and Accountability Act of 1996).

Medical biller job profile requires multiple skill sets and experience and is an important position as the revenue cycle of a set up depends on accurate and timely bill submissions. So, the role of a medical biller requires someone who is self-motivated and ready to work in a team setup