A Medical Biller is responsible for managing patient billing details, ensuring the accurate and timely submission of claims to insurance companies, and securing reimbursements for healthcare services. This role plays a vital part in verifying patient insurance coverage, coding medical procedures, and addressing patient inquiries regarding billing.

Key Responsibilities:

• Patient Data Management:

  • Confirm patient insurance eligibility and coverage.
  • Collect and maintain precise patient demographics and billing information.

• Claims Submission:

  • Submit insurance claims electronically or on paper to third-party payers, including Medicare, Medicaid, and private insurers.
  • Verify claims are complete, accurate, and free of errors before submission.

• Insurance Follow-up:

  • Track the status of claims, and follow up with insurers regarding rejected or denied claims.
  • Collaborate with insurance representatives to resolve discrepancies or payment issues.

• Patient Billing and Inquiries:

  • Generate and send patient statements for out-of-pocket expenses (e.g., co-pays, deductibles, or non-covered services).
  • Address patient inquiries about billing, payment options, and insurance coverage.

• Payment Posting:

  • Post insurance and patient payments into the system, ensuring accuracy and up-to-date accounts.
  • Handle adjustments, payment rejections, and refunds.

• Compliance and Documentation:

  • Ensure patient confidentiality and adherence to HIPAA regulations.
  • Stay informed on changes in medical billing procedures, software, and healthcare regulations.

• Reports and Reconciliation:

  • Prepare management reports regarding claim status, unpaid claims, and revenue cycle performance.
  • Reconcile account discrepancies and ensure all payments are processed correctly.

Skills and Qualifications:

• Education: Postsecondary education or certification in medical billing or coding preferred.
• Certifications: Certified Professional Biller (CPB) certification is an advantage.
• Technical Skills: Proficiency in medical billing software (e.g., Epic, Cerner, 3M), MS Office Suite, and EHR systems.
• Knowledge: Familiarity with medical terminology, ICD-10, CPT, and HCPCS coding systems. Strong understanding of insurance policies and claim submission processes.
• Communication Skills: Strong written and verbal communication skills for interacting with patients, healthcare providers, and insurance representatives.
• Attention to Detail: Ability to identify and correct errors or discrepancies in patient data and billing information.

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