As a medical biller, you will work in hospitals or other types of medical facilities, obtaining payment from insurance companies. The medical biller determines which procedure was performed on a patient and then sends out the billing invoice to the insurance carrier. This is a two part job that involves applying a code that represents the treatment and medications that were received by the patient, then submitting important information to the patient’s health insurance carrier and following up with the insurance provider to have the services reimbursed.
Billing Specialist Career Information
The billing specialist will use the patient’s records in order to determine what they should charge the health insurance company for services that were provided. The medical coder will also enter patient information into the medical facilities database in order to keep track of which medical procedures were administered. Coders also calculate expenses for services and will then prepare a list for medical billing statements and medical insurance invoices. A billing specialist will also need to submit additional patient information should the insurance company deny the claim.
Medical specialist are not required by law to have completed a formal training program in order to work in this field, but the completion of a certificate or degree program will be required by most employers. Coursework included in a certificate program will involve classes in medical billing software, medical terminology, medical billing software and medical law and ethics.
These programs will also teach beginner and advanced medical coding courses. Medical coding involves assigning codes for medical procedures using different types of coding reference books. Codes are assigned for different medical procedures, for example, if a patient has a car accident and suffers a broken right arm, ribs and a broken left leg. There will be a special code for the left leg, car accident, etc. should a coder assign the wrong codes the insurance provider can deny coverage.
To determine the reimbursement rates the coder will use assigned procedure codes. The billing specialist will also review a patient’s chart, writing down the appropriate codes that will need to be entered into the medical facilities system. Some medical coders are both coders and billers but this can vary depending on the facility in which they work.
The Difference between Medical Billing and Medical Coding
When it comes to the job description for the medical coder, they are responsible for reading notes written by the physician in order to identify procedures and the medications that were administered, following up with a physician as needed in order to clarify the services that were provided and applying the correct codes to the information that was provided by the patient in addition to the diagnosis and treatment by using different coding systems such as the HCPCS, CPT and the ICD9.
The biller will act as the link between the health care provider, insurance company and the patient. They’re responsible for taking the coded information from a patient’s visit to a medical facility and preparing and submitting a claim to the proper source. They also work by following up with claims and will make contact with insurance carriers until reimbursement has been received. As a biller you will need to have a strong knowledge of the different types of insurance providers and you’ll also need to be familiar with regulations and different billing processes. This can include Tricare, commercial claims, blue shield, Medicare, blue cross, Medicaid and workers compensation. A biller will handle varieties of administrative tasks, with the main purpose being to handle insurance processing for all medical care services, procedures, consultations and medications.
