Medical Billing/Denials Account Representative
Medical Billing entails the submission of claims information to the insurance companies. Medical billers deal primarily with payers and ensuring that the claims the healthcare organization submits get reimbursed appropriately. Sometimes these roles are also known as Patient Account Representatives. Some organizations also have medical billers deal with other back end processes like payment posting, electronic claims submission and writing appeals after a claim is denied. As a credentialed medical coder, you can utilize the experience you demonstrated by obtaining your credentials by reviewing claims before they are submitted to the insurance company. Submitting electronic claims usually is utilized through a system where a claim goes through a series of edits, (also known as a claims scrubber) where it is scrubbed and cleaned to be submitted electronically. Usually denials occur because these edits are ignored or not effectively put into place.
Medical billing can be a great way to become familiar with claim edits required for clean claim submission. You can also learn about the many rules and regulations that dictate appropriate and legal payer reimbursement including Medicare, Medicaid, Third Party plans like Workers Compensation and Commercial payers. Utilize and understand valuable resources like the CMS claims processing Manual and your payer criteria and guidelines for reimbursement.
Ziprecruiter.com lists Medical Biller Responsibilities including:
- Ensure patient information is accurate and complete
- Request any missing patient information
- Follow all regulations and guidelines set by Medicare, state programs, and HMO/PPO
- Transfer insurance claims and billing data to billing software
- Create both paper and electronic copies of documentation
- Respond to questions and complaints from patients or insurance companies
- Follow-up on late or missed payment notices
- Monitor and resolve financial discrepancies
- Arrange payment plans and timelines for payments
- File and maintain organized documentation of all billing and record
- Follow set billing processes and procedures
- Update and review all accounts to keep records of payments up-to-date
- Work with personal information and maintain patient confidentiality