How to Become a Medical Biller

Overview

A medical biller, also known as a billing clerk, collects and tracks the outstanding balances owed to a physician’s office, medical facility, hospital, etc. In other words, as a medical biller, your primary duty will be to file a provider services claim and submit it to an insurance company or a self-pay patient for payment. You will also be responsible for maintaining patient payment records and collecting on past due accounts. If the patient cannot pay his/her bill in full, you may be responsible for offering payment options to the patient. Other tasks that you may perform include: tracking the claim to ensure the medical facility receives reimbursement for provider services and suggesting ways to improve billing services.

Your duties may vary according to the size of the medical facility. Your day will more than likely consist of collecting billing data (such as: charge entry, claims processing, posting of payment, insurance billing follow-ups and/or patient billing follow-ups).  In addition, you will regularly communicate with a variety of healthcare professionals (nurses, doctors, technicians, etc.) to verify diagnoses and/or request additional information. Moreover, you will need to know how to accurately read and understand medical records that contain codes like HCPCS Level II, CPT and ICD-9-CM.

Educational Requirements

To become a medical biller, you will need to acquire a high school diploma or general education diploma (GED). You will also need to complete a medical billing and coding training program, typically offered at technical schools and community colleges. Although you do not have to have a college degree to enter this field, many employers prefer that their employees have a two or four year college degree in a healthcare field.

Course topics that you should take when training to be a medical biller:

  • Medical Basics
  • Healthcare Claim Cycle
  • Anatomy
  • Medical Terminology
  • Disease Processes
  • ICD-9-CM Coding
  • Medical Practice Management Systems
  • Billing and Coding Applications
  • Coding with Simulation
  • CPC Prep
  • CPC Review

It is important to note that most medical billers gain the majority of their knowledge and experience through hands-on job training. The length of training varies, but it is typically completed within four weeks. During training, you learn the company’s policies and procedures. In some cases, your employer may require you to take college courses in order to continue employment.

Job Duties

As a medical biller, you will more than likely work in a hospital, insurance company, bank, medical office, collection agency, clinic, private practice or government agency. You will collect on past due accounts, mediate between medical facilities, collection agencies and courts, bill patients and/or insurance companies, track collections, start claims for unpaid bills when the patient is deceased and/or manage payroll deductions for employees. In addition, you may be responsible for making sure your department is compliant with local, state and federal regulations and hospital practices.

You may also be required to perform the following tasks:

  • Updating and maintaining financial records
  • Calculating provider services charges
  • Assisting customers with their questions and concerns
  • Completing financial transactions
  • Complying with insurance rules and regulations
  • Having extensive knowledge of various insurance carriers (in conjunction with their claim requirements)
  • Understanding the appeals process for denied claims
  • Adhering to the best practices and excellent public relations when it comes to patient and insurance collections
  • Lowering risks by having a good grasp on Fair Debt collection practices, remaining professional and courteous at all times, following all rules and regulations, filing accurate claims within deadline, refunding patients and the insurance company when necessary and adhere to all local, state and federal regulations
  • Using reports as indicators for possible areas of improvement

Salary Prospects

Although most medical billers work full time, some work part-time. In fact, according to the U.S. Bureau of Labor Statistics (2013), in 2010, there were approximately 1.5 million medical billing jobs in the United States and approximately 16% of those jobs were part-time. You can expect to make approximately $35,000 per year, on average, as a medical biller. If you fall in the lower 10%, you can expect to make approximately $23,000 per year, but if you fall in the upper 10%, you can expect to make approximately $50,000 or more, per year (bls.gov).

Career Outlook

The career outlook for medical billers is favorable. In fact, medical billing jobs are expected to increase 20% by 2020 (bls.gov).  Job growth will occur as a result of a high turnover rate. In other words, as medical billers leave the occupation, there will be a need for new medical billers. In addition, employers will need more medical billers as the demands for healthcare services increases. Moreover, as technological needs increase in medical facilities so will the need for medical billers. Furthermore, the use of electronic medical records, the increase in health problems associated with aging and the continued increase in medical treatments will require medical billers that understand computer software, coding and technology.

References and Further Reading

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