The main function of a medical biller is to submit medical claims to insurance companies and payers such as Medicare and Medicaid. 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.
Obtain referrals and pre-authorizations as required for procedures
Check eligibility and benefit verification
Review patient bills for accuracy and completeness and obtain any missing information
Prepare, review, and transmit claims using billing software, including electronic and paper claim processing
Knowledge of insurance guidelines, including HMO/PPO, Medicare, and state Medicaid Follow up on unpaid claims within standard billing cycle timeframe
Check each insurance payment for accuracy and compliance with contract discount
Call insurance companies regarding any discrepancy in payments if necessary
Identify and bill secondary or tertiary insurances All accounts are to be reviewed for insurance or patient follow-up
Research and appeal denied claims
Answer all patient or insurance telephone inquiries pertaining to assigned accounts.
Set up patient payment plans and work collection accounts
Update billing software with rate changes
Updates cash spreadsheet, runs collection reports
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 Entry to 2 years of experience.
Knowledge of HMO/PPO, Medicare, Medicaid, and other payer requirements and systems.
Use of computer systems, software, 10 key calculator
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
Able to work in a team environment
Problem-solving skills to research and resolve discrepancies, denials, appeals, collections
Knowledge of accounting and bookkeeping procedures
Knowledge of medical terminology likely to be encountered in medical claims