Medical Biller

Insurance Billing Specialist Summary

• Collect and entering claim information.
• Post insurance and patients and manage accounts.
• Submit claims and following up with insurance carriers on unpaid or rejected claims.
• Answer patient inquires on account status and charges.
• Typically reports to billing supervisor or provider office manager.

Knowledge, Skills, & Abilities

• Enters information necessary for insurance claims such as patient, insurance ID, diagnosis and treatment codes and modifiers, and provider information. Insures claim information is complete and accurate.
• Submits insurance claims to clearinghouse or individual insurance companies electronically or via paper CMS-1500 form.
• Answer patient questions on patient responsible portions, copays, deductibles, write-off’s, etc. Resolves patient complaints or explains why certain services are not covered.
• Follows up with insurance company on unpaid or rejected claims. Resolves issue and re-submits claims.
• Prepares appeal letters to insurance carrier when not in agreement with claim denial. Collect necessary information to accompany appeal.
• Prepares patient statements for charges not covered by insurance. Insures statements are mailed on a regular basis.
• May work with patients to establish payment plan for past due accounts in accordance with provider policies.
• Provides necessary information to collection agencies for delinquent or past due accounts.
• Posts insurance and patient payments using medical claim billing software.
• May perform “soft” collections for patient past due accounts. This may include contacting and notifying patients via phone or mail.
• For patients with coverage by more than one insurer, prepares and submits secondary claims upon processing by primary insurer.
• Follows HIPAA guidelines in handling patient information.
• May periodically create insurance or patient aging reports using the medical practice billing software. These reports are used to identify unpaid insurance claims or patient accounts.
• Understands managed care authorizations and limits to coverage such as the number of visits. This is encountered often when billing for specialties.
• May have to verify patient benefits eligibility and coverage.
• Ability to look up ICD 10 diagnosis and CPT treatment codes from online service or using traditional coding references.

Behavioral Attributes

• Knowledgeable on insurance and reimbursement process.
• Good math and data entry (typing) skills.
• Exercises good judgement and discretion.
• Familiarity with HIPAA privacy requirements for patient information. Maintains and protects confidential information.
• Proficient in use of computers and common office equipment.
• Good verbal and written communication skills.
• Basic understanding of medical ICD 10 codes and CPT medical billing codes.
• Good telephone and patient relation skills.
• Detail oriented and ability to prioritize work.
• More experienced insurance billing specialists work with minimal direction and oversight.