What exactly do medical billers do?

Job Description 

A medical biller takes the responsibility of submitting the patient’s medical claims to insurers and payers like Medicaid and Medicare. The position is responsible for the financial health of the organization so that the providers get paid. You can find medical billers in nursing homes, hospitals, healthcare facilities, and physician offices. 

Job Duties 

A day of the medical biller calls for specific occupational duties with allocated time for the timely submission of the claims. Being said that, it includes: 

• Medical biller helps in getting the insurance pre-authorization and referrals for the patient procedures. 
• A medical biller verifies the insurance eligibility and benefits for hospitalization and treatments. 
• They scrutinize the details of the bills for accuracy and complete the incomplete information. 
• Prepare, review, and transmit the claims through the medical billing software, paper, and electronic medical claim processing. 
• Regular follow-up on unpaid claims within the period so that the health providers get paid. 
• Check for payments with compliance and accurateness. 
• Medical billers talk with the insurance companies regarding the payment discrepancies. 
• They identify the denied claims and appeal for reimbursement. 
• Medical billers answer patient inquiries of insurance within the compliance. 
• They help in incorporating the payment plans for the patients. 
• Medical billers update the billing software with the rate changes, cash spreadsheets, and running reports. 

Education and professional experience prerequisites 

As a medical biller, you must have a high school diploma and a degree in Accounting, Business Administration, or Health Care Administration. The minimum work experience is subjective and depends on the complexity of the job. A minimum experience of one to three years is preferable on the application. 

Skills Required 

A potential employer will seek the skills that you have used before: 

• Understanding of ICD-10 and CPT coding 
• Hands-on knowledge with Medicaid, Medicare, HMO/PPO, and other payers guidelines Proficient with billing software 
• Good communication skills to talk to insurers to resolve any discrepancies 
• Customer service skills to interact with diverse backgrounds and able to interact with patients regarding the claim 
• Ability to research details related to claims and appeals 
• Competent with medical terminology 
• Work within the compliance in maintaining the patient confidentiality as per the HIPPA (Health Insurance Portability and Accountability Act of 1996) 
• Experience with bookkeeping procedures and accounting 

The salary of the medical biller ranges from $26,550 to $66,260, depending upon individual education, job location, performance, and year of experience. The median salary for a medical biller 

also varies whether you work in a nursing home, large medical center, small individual practice, or group practice. This position also offers profit sharing and bonuses depending upon the company or regional area.  

Certifications required to become a medical biller  

Healthcare providers prefer certified medical billers as a part of a team. CMRS Exam (Certified Medical Reimbursement Specialist) is the most recognized certification overseen by the CBAMBA (Certifying Board of the American Medical Billing Association). The prerequisite is that you pass with 85% to be certified as a medical biller.