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Medical Biller Career Guide

Are you a detail-oriented person who enjoys paperwork and working with numbers? A position as a medical biller may be right for you.

Medical billers are responsible for the timely submission of medical claims to insurance companies and payers such as Medicaid and Medicare. It is a critical position because the financial security of health care providers depends on these actions, from single-physician practices to large medical centers and hospitals.

Medical billers may work in physician’s offices, hospitals, nursing homes, or other health care facilities.

Sample job description

Medical billers play a critical financial role in the healthcare industry. They are responsible for managing incoming and outgoing payments for medical care. This includes billing insurance and processing payments while communicating with various patients about their outstanding balance. Medical billers need to be knowledgeable about patient charts and medical codes to assess how much patients owe and how much their insurance is willing to cover. [Your Company Name] is searching for an expert medical biller to join our team. We’re looking for someone who has previous experience in medical billing or coding and has a passion for working with others. If you have strong computer skills and effective communication skills, we would love for you to apply to our open position as a medical biller.

Typical duties and responsibilities

  • Perform posting charges and completion of claims to payers on time
  • Obtain referrals and pre-authorizations as required for procedures
  • Check eligibility and benefits verification for treatments, hospitalizations, and procedures
  • Review patient bills for accuracy and completeness, and obtain any missing information
  • Prepare, review, and transmit claims using billing software, including electronic and paper claim processing
  • Follow up on unpaid claims within a standard billing cycle timeframe
  • Check each insurance payment for accuracy and compliance with contract discount
  • Call insurance companies regarding any discrepancy in payments, if necessary
  • Identify and bill secondary or tertiary insurances
  • Review accounts for insurance or patient follow-up
  • Research and appeal denied claims
  • Answer all patient or insurance telephone inquiries on assigned accounts
  • Set up patient payment plans and work collection accounts
  • Update billing software with rate changes
  • Update cash spreadsheets, and run collection reports

Education and experience

An associate degree is required for this position, preferably with an emphasis in business administration, accounting, or health care administration. A minimum of one to three years of experience in a medical office setting is preferred, as is an AAPC (American Academy of Professional Coders) medical billing certification.

Required skills and qualifications

  • Strong knowledge of Microsoft Access
  • Close attention to detail
  • Proficiency with electronic medical records
  • Ability to multitask and meet tight deadlines
  • Excellent problem-solving skills
  • Ability to manage time with little supervision
  • Maintain patient confidentiality as per the Health Insurance Portability and Accountability Act of 1996 (HIPAA)
  • Expertise in the electronic and paper systems used in billing health care systems

Preferred qualifications

  • 2+ years coding experience
  • Certified Coder (AHIMA, AAPC)
  • Ability to meet defined performance and production goals
  • Excellent verbal and written communication skills
  • Excellent organizational skills

Typical work environment

Medical billers are found working in a variety of clinical facilities, including hospitals, doctor’s offices, and outpatient centers. They are usually working independently in offices rather than directly working inpatient care units in the building. Medical billers are found sitting for extended periods of time looking on their computers or talking with patients over the phone. Most medical billers can expect to work the typical 40 hour week, however, this may vary based on the employer’s needs. 

Typical hours

The work hours for a medical biller are typically from 9 AM to 5 PM, Monday through Friday, in an office setting.

Available certifications

Many companies look for candidates that have gone the extra mile to become more competent as medical billers. Check out the following certificates:

  • Registered Health Information Technician (RHIT). The American Health Information Management Association in the United States offers this certification to help healthcare professionals learn to analyze patient data and medical records to ensure accuracy by using various computer programs. The RHIT is a great certificate to earn for anyone interested in medical billing who needs to learn the basics of coding and medical records. 
  • Certified Professional Biller (CPB). The Certified Professional Biller prepares every aspiring medical biller to enter the workforce. This certification specifically focuses on the revenue cycle to ensure the accuracy of processing payments and reimbursements. Participants will learn more about insurance plans, medical and insurance regulations, the medical billing life cycle, and claim and patient follow-up. Becoming a Certified Professional Biller will increase your expertise in the area and make you a competitive applicant when you decide to start applying to medical biller positions.

Career path

The career path for a medical biller starts by first earning an associate degree, preferably with an emphasis in business administration, accounting, or health care administration. Then specialized medical billing training is preferred, by earning the AAPC (American Academy of Professional Coders) medical billing certification.

US, Bureau of Labor Statistics’ job outlook

SOC Code: 29-2098

2020 Employment335,000
Projected Employment in 2030363,600
Projected 2020-2030 Percentage Shift 9% increase
Projected 2020-2030 Numeric Shift28,600 increase

The health care industry is increasing year after year. More people are accessing health care services, which creates a growing need for trained medical billing personnel.

One reason for this is the aging population in the United States. Older people typically need more health care than young people. As the oversized baby-boom generation ages, the demand for health care services increases.

Also boosting demand: the rising rate of obesity in the United States, as well as chronic diseases such as diabetes.

One trend in the medical billing field is in increasing customer satisfaction. Patients are demanding more empathy and understanding from health care providers’ billing departments. Another trend: the rise in artificial intelligence (AI). With the growth in patients on high-deductible health insurance plans, and the growing challenges for providers to accurately collect payments, there’s a giant opportunity gap that AI has the potential to fill. This development could negatively impact growth for the position of medical biller.