MEDICAL BILLING SPECIALIST: Job Description, Salary, Training & Certification

Medical billing is the process of creating invoices for services done and providing them to clients and insurance providers. It is the intermediary in terms of money between patients, providers, and payers. Healthcare providers wooulf not be paid for their operations without billers. So to help you understand the general idea behind this term, we will cover the fundamental ideas and rules that support the billing process. You’ll discover how insurance policies operate and how different payer categories affect the reimbursement process. Finally, we’ll talk about the rules imposed by the Health Insurance Portability and Accountability Act (HIPAA), Medicare, and Medicaid.

What is Medical Billing

The process of creating medical claims to submit to insurance companies in order to get reimbursement for medical services provided by providers and provider groups is known as medical billing. The medical biller tracks the claim after converting a healthcare service into a billing claim. To make sure the organization is paid for the work the provider completed. A skilled medical biller can boost revenue generation for the doctor’s office or healthcare facility.

The Work of Medical Billers

Medical billers coordinate payments for healthcare services with patients, healthcare providers, and insurance companies (also known as payers). Billers first gather the essential data. This contains the patient’s demographics, medical background, insurance status, and the treatments or services they have had.

Billers must check patients’ medical records and insurance policies to ensure that the treatments are covered. In order to collect this data, they produce medical claims next, ensure their accuracy, and submit them to payers. The claims are returned to billers with the agreed-upon payment once payers have approved them.

The Method of Medical Billing

Although there are several steps in the medical billing cycle that might take a few days to many months. The top priorities are accurate billing and prompt follow-up. The majority of states mandate that insurance companies settle claims in 30 or 45 days. On the other hand, payers establish claim submission deadlines that, if missed, void coverage. Without the chance to appeal, the late claim is rejected, and the organization is not entitled to compensation.

Errors can be costly in terms of lost revenue and administrative effort at any point in the billing cycle. This emphasizes how important it is for medical billers to be in control of their part in the billing process. The efficiency of front-end and back-end billing employees is crucial to the financial stability of physician practices and provider organizations. This includes hospitals, health systems, and surgery centers.

Is Medical Coding the same as Medical Billing

Medical billing and coding are two separate but connected processes. Both are essential to the healthcare industry since they are involved in informing commercial and government payers like Aetna and Medicare about diagnoses, treatments, and supplies.

Medical coders and billers must understand medical terminology, anatomy, and pathophysiology in order to comprehend physician notes and surgical reports because they collaborate with clinical personnel. Medical coders may work for billing businesses and occasionally take part in the billing process. It’s not unusual for the same person to work as both a medical coder and a medical biller in small physician offices. Although billing and coding are not the same, they both play crucial roles in the healthcare revenue cycle.

Job Description Medical Billing Specialist

The job description of a medical billing specialist includes calculating and collecting fees for services like procedures, tests, or surgeries. After each session, they give patients an invoice so they can quickly collect a payment, and they work closely with patients to develop a payment schedule that fits their budget the best.

Why Do You Think a Medical Biller is Good

A medical biller should be well-versed in diseases and injuries and possess strong communication skills as well as a superior education in medicine and technology. They must pay special attention to detail while preserving patient confidentiality.

A Medical Biller Works With Whom

In order to process insurance claims as fast and effectively as possible, a medical biller assists doctors and other medical professionals. To ensure that medical workers are adequately reimbursed for treatments completed, they collaborate with all medical facilities.

Back-End vs. Front-End Healthcare Billing

The front-end and back-end phases of the medical billing process can be divided into stages. Before the patient meets the doctor, or prior to pre-service billing, occurs. All patient-facing tasks necessary for appropriate billing are performed during this phase, including the front office staff.

After the patient has seen the physician, back-end billing takes place. The billing process resumes in the back office, which essentially implies that back-end activities are not patient-facing, once the medical coder has finished their duties and the billing team has access to the medical codes that represent the patient interaction.

Medical Front-End Billing

Staff that handles front-end medical billing should be knowledgeable about the payer mix used by their company. Billers can verify insurance eligibility and stay informed of filing deadlines and which payers need preauthorization of services by being familiar with the various payers and health plans the organization accepts.

#1. Registration as well as Pre-Registration

When a patient makes an appointment with the provider’s office or registers at the hospital, the processing of their insurance claim gets started. When a patient arrives at the location of service, staff often asks for their demographic and insurance information, or the patient fills out a registration form.

The billing team is better able to prevent data capture errors when they uphold standard operating procedures for patient registration. When evaluating a patient’s eligibility, and benefits, and securing prior permission, accurate patient data is crucial.

#2. Verifying Insurance Eligibility

The front desk employees must verify that the services are covered by the patient’s health plan in order to be paid for them. This stage involves checking the eligibility effective dates, patient coinsurance, copay, deductible, and plan benefits as they relate to specialty and location of care over the phone or through an insurer’s computerized eligibility verification tool.

#3. Service Point Collections

Staff members are made aware of the patient’s financial responsibilities when benefit information was discovered during eligibility verification. When the patient is at the front desk, either during check-in or checkout, the biller is able to collect the copay, deductible, coinsurance, or the entire balance outstanding.

#4. Come across Form Generation

A form created for each patient interaction is known as an encounter form, superbill, or fee ticket. The form includes a list of typical services (with their medical codes) and a space for clinicians to record diagnoses. It is printed with patient demographic information added.

The encounter form, which will be used to communicate information regarding the quantity and nature of services supplied to the patient, is created by front-end workers. The provider will check the relevant boxes at the conclusion of the patient visit and sign the form to certify that the checked services were provided and are eligible for billing. The encounter form will probably be electronic if the provider uses an EHR and practice management system.

#5. Checkout

At this time in the billing cycle, front-end personnel schedule a follow-up appointment if necessary and make sure the doctor filled out the meeting form. Additionally, check out offers a second chance for point-of-service collections. Medical coders receive the patient’s medical records after check-out and translate the billable data into medical codes.

#6. Medical Billing on the Back End

Medical billers frequently speak with doctors to get clarification on diagnosis or to learn more details about a patient contact. The medical biller is required to understand CPT®, HCPCS Level II, and ICD-10 codes as well as how to read a medical record.

#7. Cost Entry

The encounter form informs the charge entry team about the services and procedures that were carried out and their justifications. These charges, together with any payments received by the patient at the time of service, are then entered into the practice management system by the charge entry team.

The charge entry personnel must inquire with the provider for more information if they find an encounter form without a diagnosis, which payers require to support delivering medical treatment.

When reconciling patient charges, charge entry responsibilities also include charge capture evaluations to ensure that all charges and receipts were added. By comparing the total charges and payments from encounter forms with a printed system report of the day’s charge entry, this review is often conducted at the conclusion of the day.

Medical Billing Specialist Salary

According to the Bureau of Labor Statistics (BLS), the median annual compensation for medical billing and coding professionals is $46,660, or $22.43 an hour, but there are several factors that can affect your ability to make that much. For instance, medical billers and coders in New Jersey makes $67,130 annually, which is significantly more than the national average.

Additionally, certified coders make 27% more money than uncertified coders, according to the AAPC. We’ll delve into medical billing and coding wage aspects in this article, including how much you can earn in each state, the places with the highest salaries, and how medical coders’ and billers’ pay varies depending on where they work.

Medical Billing Specialist Training

The following medical coding classification systems are used by experts in medical billing and coding. Since these manuals are often utilized in the field, they are covered in many free courses. Finding a course that covers the material you’ll need to know can be made easier by becoming familiar with the abbreviations used for various classification systems.

ICD11, ICD-10-CM, and ICD-10-PCS are all parts of the International Classification of Diseases.
CPT® stands for Current Procedural Terminology.
HCPCS Level II: Healthcare Common Procedure Coding System

Medical Billing Specialist Certificate

Although certification is not necessary, professional medical billers will discover that it opens up more job prospects, improves remuneration, and increases the likelihood of major career advancement.

We’ll categorize the various medical certifications according to the entity that issues them. We will briefly discuss the American Medical Billing Association (AMBA) and the American Association of Professional Coders (AAPC), the two main certification bodies in the field of medical billing.

#1. The AMBA

The AMBA is a business association that only works in the area of medical billing. Through the Certified Medical Reimbursement Specialist (CMRS) test, the AMBA has been certifying medical billing specialists for more than ten years.

#2. AAPC

The American Association of Professional Coders, the leading association for health information specialists, mostly focuses on medical coding but also offers certification in medical billing.

Medical billers who pass the Certified Professional Biller (CPBTM) exam can obtain this credential, which assesses them on all facets of the billing industry. This certification, like the CPCTM covered in Courses 1-4, is a demanding yet well-respected barometer for experts in the field of health information.

How Much Do Medical Billers Make in New York?

Medical billing and coding specialists in New York make an average of $54,113 a year. In case you need a quick pay estimator, that comes out to about $26.02 per hour.

Is Medical Billing a Stressful Job?

Medical billing and coding can be a demanding profession. Stress can be too much to take at times. Even the strongest people might become weak under such pressure crack. Stress can negatively impact your mental and physical health if you do not learn how to manage it.

What is the Highest Paid Medical Biller?

Compensation Consultant. Salary range: $75,001 to $97,500 annually.
Compensation Analyst. Salary range: $49,500 to $85,500 annually.

What is the Top Pay Medical Billing and Coding?

The highest-paying medical coding positions can earn up to $75,000. Although a degree is not necessary, many employers favor applicants who hold the Certified Professional Coder (CPC) credential or an associate’s degree in medical coding.

Can Medical Coders Make Six Figures?

Peer reviewers, supervisors, and then auditors are all positions that experienced coders might take on to increase their earning potential. Additionally, they can work as consultants and start making six figures. One occupation in the US healthcare sector that offers both freedom and a competitive salary is medical coding.

Do Medical Billers Make More than Coders?

Medical billing specialists make an average of $54,789 a year, compared to the average national salary of $35,246 for medical billers. Higher salaries may be earned by seasoned professionals in the field and those who double as billers and coders.

Conclusion

The demand for highly qualified, highly professional medical billers has increased as a result of growing reimbursement challenges in the healthcare sector. There is a strong demand for professionals who are familiar with medical insurance, reimbursement procedures, and the claims process.

The largest medical coding and billing training and certification group in the world, AAPC, offers flexible training alternatives if you’re thinking about becoming a certified professional biller. Today, be ready for a future in medical billing and the CPB certification!