What Does a Medical Biller Do?
A medical biller manages the billing insurance and processing payments for clients. They prepare and submit claims for medical procedures and services provided to insurance companies, communicate with patients about outstanding balances, and collect payments for the provider institution. They must have good attention to detail and ensure that patient medical information is accurate and up to date. They must also be able to analyze medical data and use sound judgment when needed. Strong written and verbal communication skills are necessary as they work with patients, clients, collection agencies, and insurance companies.
A medical biller’s daily responsibilities often include things like monitoring accounts, working with patients to develop payment arrangements, and pursuing delinquent accounts. They need an in-depth understanding of billing software, electronic medical records, and medical codes. Medical billers typically work in physician’s offices, hospitals, nursing homes, or other healthcare facilities.
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National Average Salary
Medical biller salaries vary by experience, industry, organization size, and geography. To explore salary ranges by local market, please visit our sister site zengig.com.
The average U.S. salary for a Medical Biller is:
Medical Biller Job Descriptions
The first step when hiring a great medical biller is a well-crafted job description. Below are real-world examples to help give you the best chance of success on your recruiting journey.
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
- 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
Seeking an individual with medical billing and EMR billing software experience who strives to deliver the highest of customer service standards. This position is responsible for supporting the Account Management team by posting payments, capturing/working denials, and working outstanding accounts receivable (A/R) balances.
- Post all insurance payments, contractual and non-contractual adjustments for assigned carriers by CPT code and transfer outstanding balance to secondary insurance or patient responsibility per EOB protocol
- Conduct audits and coding reviews to ensure all documentation is accurate and precise
- Assign and sequence all codes for services rendered
- Assign codes to diagnoses and procedures, using ICD, and CPT codes
- Search for information on cases where the coding is complex and unusual
- Close payment batches daily, reconciling individual carrier payments and EOB statements
- Initiate processes to follow up on rejected claims as evidenced by EOBs, per EOB protocol
- Transmit all appropriate electronic and paper claims, correct any errors on claims and re-transmit; file secondary claims as necessary
- Discuss outstanding payment amounts with patients regarding balance owed by the insurance company and the patient
- Post all payments, by line-item, received for physician’s professional services into EMR software system including co-payments, insurance payments, and patient payments in accordance with practice protocol with an emphasis on accuracy to ensure maximum patient satisfaction and profitability. All payment batches must be balanced in both their dollar value of payments and adjustments prior to posting
- Review the physician’s coding at charge entry to ensure compliance with Medicare guidelines and to ensure accurate and timely reimbursement
- Provide customer service on the telephone and in the office for all clients and authorized representatives regarding patient accounts in accordance with practice protocol. Patient calls regarding accounts receivable should be returned within 1 business days to ensure maximum patient satisfaction
- Verify all demographic and insurance information in patient registration of the EMR software system at the time of charge entry to ensure accuracy, provide feedback to clients and supervisor to ensure timely reimbursement
- Provide information pertaining to billing, coding, managed care networks, insurance carriers, and reimbursement to physicians, managers and subordinates
- Follow-up on all returned claims, correspondence, denials, account reconciliations and rebills within five working days of receipt to achieve maximum reimbursement in a timely manner with an emphasis on patient satisfaction
- Submit primary and secondary insurance claims electronically each day and on HCFA to ensure timely reimbursement
- Process refunds to insurance companies and patients in accordance with client protocol
- Monitor reimbursement from managed care networks and insurance carriers to ensure reimbursement consistent with contract rates
- Proficiency with all facets of the EMR software system including patient registration, charge entry, insurance processing, advanced collections, reports, and ledger inquiry
- Provide cross coverage for Account Managers in their absence as required to ensure efficient and professional practice operation
- Maintain information regarding coding, insurance carriers, managed care networks and credentialing in an organized easy to reference format
- Maintain an organized, efficient, and professional work environment
- Adhere to all practice policies related to HIPAA and Medicare Compliance
- Preferred 4 years experience in a medical office reimbursement department or medical billing service
- Highly Preferred Ophthalmology Experience – and experience in Nextech, Nextgen, or other ophthalmology specific EMR/PM software
- Strong background in Accounts Receivable
- Strong communication skills as you will be speaking with physician’s, patients, insurance representatives, and/or medical billing staff on a weekly basis
- Must maintain HIPAA standards
- Ability to work in a fast-paced environment while remaining calm and professional
- Strong customer service orientation
- Excellent organizational skills and must be detailed oriented
- Strong computer and typing skills
- Outstanding listening skills
- Positive, friendly, approachable disposition
- Ability to work with multiple priorities
Join a great orthopedic office that is patient focused and family oriented! We are looking for an energetic, team player who is detail oriented and reliable. This person must have medical billing and coding experience. We would prefer someone with orthopedic experience. Knowledge about DME billing is a plus.
Essential functions and duties:
- Assign appropriate diagnosis codes using ICD-10
- Assigns appropriate procedure codes using CPT and HCPCS
- Links proper diagnosis code with appropriate CPT code for billing purposes
- Verifies the place of service
- Query physician for when additional information is needed to complete accurate coding tasks
- Processing of clinical professional charges in a timely and accurate manner, reviewing, and processing claims edits for accuracy as well as insurance and coding compliance
- Review submitted claims and work claim rejections
- Perform collection activities, such as working aged accounts/AR reports to ensure timely and proper maximum reimbursement through various methods including insurance company websites, phone calls, etc.
- Accurately posts insurance payments received in the mail or through ERA. Posts appropriate denials and tasks to the appropriate team member
- Maintain working knowledge of changes in medical insurance plans as it pertains to claim billing
- Provides professional, accurate and timely responses to all accounts receivable inquiries over the phone and in person
- Minimum High School or equivalent
- Certified Biller: CPC or AAPC Certification
- Medical Billing/Coding: 2 years
- Orthopedic experience
The ABC Company is currently looking for an individual with Medical/Behavioral Health Insurance billing experience, who is able to handle a high volume of claims. Successful candidates are those who posses the ability to work quickly and independently, with the ability to multitask and enjoy a fast paced environment.
- Perform behavioral health claim billing via electronic submission through a Clearing House
- Reading and interpreting insurance explanation of benefits (EOBs)
- Track claim payments and resolve rejected claim issues by re-submitting claims or contacting appropriate insurance companies when applicable
- Draft effective appeals to insurance companies
- Utilize reports to follow up on unpaid claims in a timely manner
- Maintain working knowledge of state and federal billing guidelines
- Willingness to cross train as needed
- Other billing related tasks as needed
- 2 or more years experience in medical/Behavioral Health billing
- Experience working with (State) Medicaid/Medicaid MCO’s required
- Knowledge of Inpatient/Outpatient Behavioral health billing a plus
- Strong Computer Skills a plus
- Working knowledge of Insurance Coordination of Benefits
- Experience with prepayment/post payment audits
- Working knowledge of Microsoft Excel, Word, and Outlook
- Knowledge of CPT billing codes for Behavioral Health
- Problem solving, detail oriented, communication, and organizational skills
- Ability to work independently
Candidate Certifications to Look For
- 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. Candidates 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 a candidate’s expertise in the area and make them competitive applicants when they decide to start applying to medical biller positions.
How to Hire a Medical Biller
Consider the following when hiring a medical biller:
- Recruiting: Do you have the internal resources and tools to source and recruit for this role successfully?
- Complexity: Do you need a senior professional, or will mid, or even junior-level skills suffice?
- Duration: Is this a one-time project, or an indefinite need?
- Management: Can you effectively direct the work effort?
- Urgency: Are there any deadlines associated with this need?
- Headcount: Do you have the budget and approval for an internal employee, or should you consider alternate options?
Answering these questions will help determine the best course of action for your current hiring need. Fortunately, various great options exist for every scenario, no matter how unique. We recommend the following options when hiring a medical biller:
1. Use 4 Corner Resources (or another professional recruiting firm)
The heavy lifting is done for you when working with a top-tier staffing company like 4 Corner Resources. We source, screen, recruit, and deliver only the most qualified candidate(s), saving you significant time and effort throughout the hiring process while you remain focused on your core business. Understanding your needs and ensuring the right candidate for the position is the key to our success.
This is the best route to take when:
- You need to fill the position quickly
- You want access to a vast talent pool of high-quality, prescreened candidates
- Your position is suited for temporary hiring services, contract staffing, or contract-to-hire recruiting, and you intend to direct the work activity.
- You are hiring an employee as a direct placement but aren’t able to recruit effectively or efficiently with your internal staff.
- You aren’t familiar with current salary rates, market trends, and available skill sets
2. Advertise your opening on a top job board
Your best option may be to advertise your opening on a proven job board. There are many widely used job sites out there that draw visits from qualified candidates. If you have someone internally who can dedicate the time and energy to sort through applications and screen individuals effectively, this can be a great choice.
We recommend using a job board when:
- Your internal recruiting team has the knowledge and experience to assess candidate qualifications
- You are hiring a direct employee and have time to manage the entire recruiting effort
- You have a process for receiving, screening, and tracking all resumes and applications
- You are prepared to respond to all applicants
We recommend CareerBuilder when hiring a medical biller:
CareerBuilder has been a trusted source for hiring since 1995. Reach 80+ million unique, diverse U.S. job seekers annually by posting your jobs through their talent acquisition channels. Through CareerBuilder, you can engage candidates and drive them into your sourcing pipeline. We recommend using CareerBuilder for hiring when you have the internal resources and processes to review, screen, and reply to all applicants.
3. Leverage your internal resources
You can utilize your own website, social media, and employees to assist in your search for top candidates.
A company website posting should be the first step in notifying prospective candidates that you are hiring. Social media can also be a powerful tool for spreading the word about your new opening. As far as exposure is concerned, this option can be as good as some job boards when you have a large enough following across various platforms, like LinkedIn, Instagram, Facebook, TikTok, and Twitter.
Current employees are every organization’s greatest asset. Encourage your internal team to promote job openings to their network by offering cash and other incentives.
We recommend these options when:
- Your brand has great name recognition
- You can consistently monitor and respond to candidate activity through your website and social media accounts
- You have a process in place to quickly and broadly communicate job openings and requirements
- You have an effective employee referral program in place
If you aren’t sure which path is best, schedule a discovery call today with our seasoned recruiting professionals. The 4 Corner team is on standby to help you find the best option for your unique hiring need.
Sample Interview Questions
- What are your methods for ensuring that medical claims are coded and submitted correctly and completely?
- What is your experience with medical billing software and electronic claims submission?
- What steps do you take to resolve denied or rejected claims?
- How do I verify a patient’s insurance coverage and eligibility?
- What are your methods for keeping up with the changes in medical billing codes and regulations?
- How have you dealt with billing issues with patients or insurance companies?
- To ensure timely billing and claims submission, how do you manage your workload and prioritize tasks?
- How have you worked collaboratively with other healthcare professionals to resolve a billing issue?
- What steps do you take to ensure accurate and up-to-date billing records and to ensure patient confidentiality and security?