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:
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Patient Data Management:
- Confirm patient insurance eligibility and coverage.
- Collect and maintain precise patient demographics and billing information.
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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.
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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.
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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.
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Payment Posting:
- Post insurance and patient payments into the system, ensuring accuracy and up-to-date accounts.
- Handle adjustments, payment rejections, and refunds.
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Compliance and Documentation:
- Ensure patient confidentiality and adherence to HIPAA regulations.
- Stay informed on changes in medical billing procedures, software, and healthcare regulations.
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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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