What is a medical biller?
A medical biller is a professional who handles financial transactions within a healthcare setting. They play a significant role in the healthcare revenue cycle management process, ensuring that healthcare providers are accurately reimbursed for their services. Medical billers are an important link between healthcare providers, patients, and insurance companies.
Medical billers contribute to the overall financial health and sustainability of healthcare facilities, which ultimately allows these facilities to provide ongoing care to their patients. With a detailed understanding of healthcare coding systems and insurance policies, medical billers ensure that the billing process is conducted accurately and efficiently, supporting the financial operations of the healthcare facility.
Duties and responsibilities
The primary duty of a medical biller is to process and submit insurance claims for healthcare services. Duties involve carefully reviewing each patient’s medical record to determine the treatments, medical procedures, or office visits provided. They also confirm insurance coverage and ensure that all required documentation is for submission.
Another responsibility is communicating with insurance companies to address any issues or questions about the claims. They may have to solve discrepancies and submit appeals for denied claims. Following up on unpaid claims and managing revenue collections, including patient owed amounts, are also key tasks. In addition, they often serve as the contact point for patients for any questions or clarifications about their bills.
Medical billers usually work in an office environment within healthcare settings, such as hospitals, clinics, and nursing homes. Some billers may work for medical billing companies that provide services to multiple healthcare facilities. The job usually involves working on a computer, managing electronic health records, and using billing software. It requires attention to detail as it involves dealing with crucial patient and financial data.
Typical work hours
Medical billers typically work regular business hours, from 9:00 A.M. to 5:00 P.M., Monday through Friday. Depending on the healthcare setting, some evening or weekend hours may be required. In certain cases, particularly at medical billing companies, billers might have the opportunity to work part-time or remotely. Like other administrative jobs, the role can be flexible in terms of scheduling, but it often depends on the specific employer’s requirements and workload.
How to become a medical biller
This career guide section outlines the process of becoming a medical biller. The primary stages in this path involve garnering the right education and experience, obtaining the necessary certification, and mastering key job-specific skills.
Step 1: Obtain a high school diploma
An essential initial step in becoming a qualified medical biller is obtaining a high school diploma or equivalent – a basic requirement for most employers.
Step 2: Pursue post-secondary education
While only sometimes required, a degree in areas related to health services or administration can be beneficial. Courses in medical terminology, anatomy, healthcare law, and insurance practices provide a solid foundation for a prospective biller.
Step 3: Gain relevant experience
Securing an entry-level job in a healthcare setting, such as a receptionist or administrative assistant, is advisable. This experience allows for interaction with healthcare professionals and patients, enhancing understanding of healthcare operations and patient interactions, which are pivotal in medical billing.
Step 4: Obtain certification
It’s advantageous for aspiring medical billers to get certified, despite not being a strict requirement. The Certified Professional Biller (CPB) designation, delivered by the American Academy of Professional Coders (AAPC), is nationally recognized and offers an edge in the job market. The process involves passing an examination that tests knowledge in areas such as types of insurance, billing regulations, and claim submission processes.
Step 5: Continue professional development
Once working as a medical biller, it’s important to stay current with ever-evolving medical codes, billing software, and changes in insurance plans and healthcare laws. Consider participating in professional development opportunities offered by certification bodies, employers, or reputable online platforms.
How much do medical billers make?
Medical biller salaries vary by experience, industry, education, location, and organization size. Unique factors that impact compensation include specialization, certifications, and familiarity with specific coding systems.
Highest paying industries
- Pharmaceutical and Medicine Manufacturing – $54,770
- Scientific Research and Development Services – $53,100
- Insurance Carriers – $49,520
- Federal Executive Branch – $48,920
- Management of Companies and Enterprises – $47,810
Highest paying states
- Alaska – $46,520
- Massachusetts – $44,690
- Connecticut – $44,360
- Washington – $43,890
- New Jersey – $41,720
Types of medical billers
Below, we explore common career types and areas of specialization for medical billers. This section provides an overview of the different roles available
Hospital medical billing
These specialists process patient data, such as treatment records and insurance information. They’re responsible for submitting claims to insurance companies and ensuring the hospital receives appropriate compensation for services rendered. Due to the vast array of treatments and procedures administered in hospitals, these individuals often have a high level of expertise in various medical billing codes.
Physicians’ office billing
Another common role is based in physicians’ offices. Many physicians hire in-house medical billers to manage the billing process. These professionals may be responsible for a smaller volume of claims, but they typically play a more comprehensive role that covers billing, coding, and direct interaction with patients. Familiarity with the specific types of treatments typically offered in a physician’s office is often required.
Many health establishments outsource their billing to a third-party company, creating another career path within this field. These companies handle billing for multiple clients, and their representatives must be knowledgeable about a wide range of medical procedures and billing practices. The role also often includes extensive communication with healthcare providers, insurance companies, and occasionally patients.
Some proficient medical billers choose to offer their services on a freelance basis, which requires managing all aspects of the billing process for multiple clients, often on a contract basis. Freelance medical billers must be self-motivated, well-organized, and capable of keeping up with various clients’ needs. These individuals need a strong understanding of medical coding, billing software, and insurance processes.
Public health department billing
Last but not least, medical billers work directly for public health departments. These specialists handle billing for various health services provided by government agencies, focusing on ensuring all charges are correct, submitted promptly, and paid by either the individuals receiving services or the appropriate government agency. These roles usually require a deep understanding of public health policy and the specific rules around government-funded health programs.
Top skills for medical billers
This career guide section outlines the skills and abilities that will help you find success as a medical biller.
Attention to detail
In this profession, even the smallest mistake can lead to substantial errors in billing statements, leading to delayed or denied payments. This trait enables you to spot and rectify discrepancies in medical codes, insurance policies, or patients’ information.
Medical coding knowledge
Medical coding is an integral element of this role as it relates to translating patient diagnoses, procedures, and medical services into universally accepted codes. A solid grasp of these codes is required to produce accurate and efficient healthcare claims.
Billing software proficiency
Being adept at using billing software and general-purpose applications like word processors, spreadsheets, and email, is necessary to manage the data and maintain communication with patients, healthcare providers, and insurance companies.
Billers work with diverse individuals throughout the workday, requiring strong interpersonal skills. Clear, concise communication can mitigate misunderstandings and expedite payments.
Understanding of health insurance policies
Familiarty with various health insurance policies and their respective coverage is pivotal to accurately calculating patients’ dues and verifying claims. This knowledge can help avoid claim denials and facilitate smooth transactions.
Career path options
As a medical biller, there are many avenues for advancement. Taking on a leadership or management role in the billing department, like a billing supervisor or manager, is often an attractive step forward. Responsibilities in these roles include overseeing a team of billers, ensuring accurate and efficient operations, and engaging in a strategy to improve revenue cycle management.
Earning certifications like Certified Professional Coder (CPC) opens doors to a medical billing and coding specialist position – a role that entails coding procedures, diagnoses, and treatments – a skillset highly valued in the healthcare industry.
With enough experience and knowledge, there is an opportunity for medical billers to transition into medical practice management. This position usually involves overseeing operations of a healthcare facility or a specific unit within a facility, including staffing, budgets, and policy development.
Those with extensive expertise may venture into a consulting role – independently or as part of a firm. Healthcare consultants use their insights to advise healthcare facilities on various aspects, including billing practices, revenue cycle management, and regulatory compliance. This step often requires a breadth of skills ranging from strategic planning to problem-solving.
In addition to these broad career options, pursuing specializations like pediatric or oncology billing could be an attractive choice. By gaining expertise in a certain field, you can position yourself as a sought-after professional.
Similar job titles
Position trends and outlook
One of the significant trends involving medical billing professionals today is the increased emphasis on technology. Modern medical billers are finding themselves in need of greater familiarity with digitized systems and software as the industry moves towards more electronic data handling. Gone are the days when keeping track of patient data and billing information required vast amounts of paperwork alone. Today, proficient use of specialized medical billing and coding software is an important attribute for a candidate in this field.
There are also more opportunities for medical billers to work remotely – a trend that increased rapidly due to Covid. Professionals with the space and acumen to work efficiently and effectively at home have a unique advantage in this competitive field.
According to the Bureau of Labor Statistics (BLS), employment for medical records specialists (which includes billers) is forecast to grow 7 percent through 2031 – faster than the average for all occupations. The demand for health services will increase as the population ages, driving demand for billing expertise.
Medical biller career tips
Understand the healthcare billing process in depth
Staying informed about multiple insurance plans, their requirements, and the intricacies of various medical billing forms is vital. Familiarity with medical codes, claims processing, and federal regulations related to medical billing will also highlight your professional acumen.
Attaining professional certification can significantly enhance your career. There are several certification options available run by recognized institutions, such as:
- Certified Medical Reimbursement Specialist (CMRS)
- Certified Billing and Coding Specialist (CBCS)
- Certified Professional Coder (CPC)
Keeping up-to-date with advancements in medical billing software is crucial as it optimizes efficiency. Familiarizing yourself with popular medical billing software will make you more attractive to employers and help you perform your duties effectively.
Invest in continuous learning
Staying knowledgeable about the latest updates, regulations, and practices in the field is crucial. You can do this by taking up courses, attending webinars and seminars, or participating in workshops. Some recommended areas for continuous learning include:
- Healthcare regulations
- Advanced medical coding
- Medical terminology
- Health Insurance Portability and Accountability Act (HIPAA) rules and updates
Build a professional network
Connecting with others in your field can open doors and offer unique opportunities. Stay current in your field by joining professional associations and networks. Here are a few suggestions:
- American Association of Healthcare Administrative Management (AAHAM)
- American Health Information Management Association (AHIMA)
- American Academy of Professional Coders (AAPC)
- Healthcare Billing and Management Association (HBMA)
Where the jobs are
- Change Healthcare
- Tenet Healthcare
- New York
What type of education is needed to pursue a career in medical billing?
An associate’s degree in medical billing and coding, or a similar field, is usually required. Some employers may prefer applicants who have a bachelor’s degree. Regardless of the educational path, coursework usually includes medical terminology, anatomy and physiology, and different classification systems for diagnosing and coding diseases.
What skills are most important for success in this role?
Attention to detail is essential when processing intricate medical codes. A sound understanding of medical terminology, procedure codes, and billing practices is required. Strong communication and customer service skills are also needed to explain charges or procedures to patients and insurance companies. The ability to multitask, work independently, and use specific billing software also plays a crucial role in daily tasks.
What are the daily responsibilities in a typical medical biller role?
Typical duties include updating patient billing records, submitting insurance claims, liaising with insurance companies, arranging payment plans for patients, and rectifying rejected or unpaid claims. Billers interact with patients and insurance providers to manage payments, disputes, and inquiries. Hence, being comfortable handling sensitive matters and displaying compassion and professionalism is crucial for this role.
What kind of work environment can a medical biller expect?
Most professionals work in a healthcare setting such as hospitals, private practices, nursing homes, or home health agencies. The job typically involves spending long hours in front of computers in an office-like environment.
Are there any professional associations for medical billers?
Yes, several professional associations provide education, networking opportunities, and resources for this profession. The American Academy of Professional Coders (AAPC) and the American Health Information Management Association (AHIMA) are among the most recognized. Joining an association can enhance your professional development, offer opportunities to earn continuing education credits needed for certain certifications, and improve job prospects.
What differentiates a medical biller from a medical coder?
While their roles are interconnected and sometimes their duties overlap, they have distinct responsibilities. Medical coders translate patient treatment information into numerical codes, while billers use these codes to create insurance claims or bills for patients. Essentially, coders work on the front end by determining the correct codes for the services the patient receives. In contrast, billers work on the back end by sending out bills, managing rejected claims, and ensuring payments are made in full and on time.
What technical proficiencies should a medical biller have?
The ability to use medical billing software like Medisoft or AdvancedMD proficiently is important. A good understanding of electronic health records (EHRs) and electronic medical records (EMRs) systems is expected. Knowledge of Microsoft Office Suite, especially Excel, is also useful for managing data and creating reports..