When it comes to the medical billing job description, one generally includes the job descriptions for both medical coders and billers, as it is often one and the same person doing both jobs in small practices, although they are totally different. Although the strict definition of a medical billing job description is “assigning and translating codes for different services and diagnoses” they perform many other duties besides.
Medical coders and billers are highly sought-after in the health care industry because of the importance of the job that they do. In bigger institutions the positions are filled by different people, but even then their day-to-day duties mean that they interact with each other often. Medical billers and coders are becoming increasingly important to the medical profession as well as to the medical insurance profession.
The burgeoning medical industry in the United States, thanks to the baby-boomers now reaching an age when they require far more medical attention and the new medical discoveries that are being made daily and which allow many more conditions to be treated than before, mean that there is now a need to outsource medical billing and coding, which used to be done in-house. This has literally created two whole new careers, and the need for more billers and coders is growing daily.
Medical Coder Job Description
A medical coder or a Certified Coding Specialist works in a health care facility such as a hospital, clinic, nursing home, or a private physician’s practice. A Medical Coding Specialist is responsible for many of the tasks associated with the generation and management of records for medically billable activities.
A coding professional’s daily duties include the following:
- Assigning the appropriate medical billing codes to all medical diagnoses or services
- Ensuring that all patient medical records have been signed off by the correct parties
- Entering and organizing the codes into management software
- Obtaining necessary clarification regarding information on the physician’s notes and charts
- Reviewing a physician’s patient notes and charts for accuracy
A medical coder must know the ICD-9-CM, ICPM, DSM-IV and CPT-/HCPCS universal coding systems in order to be able to correctly allocate codes to various procedures and services. The coding systems are designed to provide all parties with a description of the patient’s condition and services rendered or processes undertaken in a totally unambiguous and standard manner that can be understood by anyone treating or dealing with the patient’s billing.
Medical Billing Job Purpose
A medical biller is referred to as a Medical Billing Clerk or a Medical Billing Specialist. A medical biller’s purpose is to generate revenue for the practice or other medical institution by making arrangements for payment, collecting outstanding monies, and monitoring and pursuing delinquent accounts. Part of the medical billing job description is that they are responsible for collecting, posting and managing account payments as well as for submitting claims and following up with insurance carriers on unpaid or rejected claims, and answering inquires from patients regarding account status and charges.
Medical Billing Job Description
Once the medical coder has assigned the codes to the billable activities that were performed at the health care facility, the Medical Biller then takes over. It is the responsibility of the medical biller to translate those codes into the terminology required by the insurance companies so that the correct billing documents can be sent out.
The medical billing job description means that the tasks that the Medical Billing Specialist must perform include all or some of the following tasks:
- Translate the medical codes into the insurance companies’ preferred coding system
- Prepare and submit appropriately coded claims documents to various insurance companies either electronically or by paper.
- Perform daily backups on the office computer billing system
- Submit all claims filed by the health care provider, organize them and track them
- Communicate with patients regarding delinquent accounts, and collect them by establishing payment arrangements with them where necessary
- Monitor payments made and follow up with patients when their payment lapses
- Utilize collection agencies and/or small claims court in order to collect outstanding accounts by evaluating and selecting collection agencies
- Determine the appropriateness of pursuing legal remedies
- Maintain work operations by following the institution’s policies and procedures
- Initiate claims against estates by monitoring deaths and unpaid accounts
- Testify for the medical facility in court cases
- Maintain Medicare bad-debt cost report by tracking billings; monitoring any collections, and collating all information
- Answer questions from patients, clerical staff and insurance companies
- Correct and resubmit claims to third party payers
- Processes payments received from insurance companies and prepare daily deposits
- Inform the legal department of the institution, if there is one, to act on probate and estate issues, and then do follow-up with the clerk of the court
- Report compliance issues
- Update job knowledge by participating in various educational opportunities so that they remain current with the latest codes
- Adhere to all HIPAA guidelines and regulations
- Maintain strict confidentiality at all times
The medical billing job description differs somewhat depending on whether the medical billing clerk specializes in a particular type of billing and on the size and type of organization in which they are employed. In a smaller facility they may be expected to perform a wider range of tasks, whereas in a large hospital they would perform more specialized tasks and may be part of a team of Medical Billing Specialists.
Changes to the Medical Billing Job Description
The medical billing job description is changing somewhat, as it is evolving, together with that of the medical coding professional, and this is due to the fact that more of these jobs are now being handled remotely by companies or individuals who work from home. This has been made possible by the increasing use of technology in the medical field, and the latest data management software. Many medical billing and coding professionals are now pursuing their studies online and are starting their own work-from-home businesses instead of working in a medical billing office or in the physician’s practice.
These changes augur well for both the employer who now does not need to provide extra space, office furniture, technical equipment, and benefits for an additional staff member, and for the medical billing and coding professionals, as they can work from the comfort of their own home at a time that suits them, and can still fulfill their domestic responsibilities such as looking after their children, etcetera.
Although the law does not require that one has a specific qualification in order to fulfill the duties as outlined in the medical billing job description, it is advisable to get some form of qualification. Many employers do require that their medical billers have some sort of medical billing certification, and most will give preference to those applicants who do.
There are various qualifications offered by reputable education institutions, including:
- Certificate Program – this is a basic course which is designed to give the individual with no previous medical experience some knowledge about coding and billing; the duration of the program is between 6 and 9 months.
- Diploma – The diploma program is the intermediate route, and the program takes 9 to 12 months to complete. It is centered on the procedures and nuances of healthcare billing, and includes training in office procedures, medical law and ethics, medical terminology and coding and billing, amongst other subjects.
- Associate’s Degree – Most of the larger institutions either require or prefer a medical billing professional to have this degree, and it is definitely the way to go if you are intending on opening a medical billing business of your own or working from home for yourself. This program takes approximately 2 years to complete.
- CMBP Online Medical Billing Training – This is the perfect course for those who want to study to become a medical biller whilst still working at their current job or continuing to raise a family. Everything is done online and the best thing about this program, which takes 3 to 6 months to complete is that it comes with specific billing/practice management software which you will use throughout your training and can use for your business afterwards.
Although you only need a high school qualification or GED equivalent, it is highly recommended that you do rather complete one of the above programs if you intend making medical billing your future career.
Registration and Credentials
It is also highly recommended that you get some further credentials such as the Registered Health Information Technician (RHIT) Credential, which is a certification that the American Health Information Management Association (AHIMA) offers, as this will stand you in good stead with future employers or clients.
If you enjoy working with figures in a challenging job, are accurate, have good computer skills and also have good communication skills, then the medical billing job description and all that it entails will suit you down to the ground.