#1: Where Do Medical Billing Professionals Work?

While medical billing is a highly specialized career, professionals in the field work in a variety of settings. Many find positions in offices, away from the action of a hospital, while others work in much more clinical settings. Increasingly, medical billing professionals are being encouraged to work remotely, which for many will mean from the comfort of their own living rooms.

Different Employers

According to data provided by the U.S. Bureau of Labor Statistics (BLS), medical records and health information technicians tend to find employment in four major industries: hospitals, physicians’ offices, nursing care facilities and home health care services.

But this isn’t the definitive list of places to work. In fact, many medical billers work for government agencies, such as the Veterans Administration (VA). Others may obtain positions with private companies that provide patients with auxiliary services or therapeutic products. Some even find employment as in-house medical billing specialists with insurance companies, and many others work for medical billing and collection services.

Workplace Environment

Depending on the size of the office, medical billers may work exclusively on claims and billing, or, as happens frequently in small doctors’ and dentists’ offices, they may also double as receptionists. Spending most of the day working at a desk, medical billers usually complete claims and billing paperwork electronically. Often, telephone contact with patients and other professionals will be required. Medical billers are almost always supervised: in small offices, the supervisor is often a physician, in medium offices, an office manager and in large organizations, medical billers answer to billing supervisors.

But because they are in such high demand, medical billers often have the luxury of choosing their work environment. Whether it’s a hospital or government office, or working alongside a doctor or bill collector, medical billing professionals find stable, well-paying work.

#2: Specific Duties and Requirements

Medical billing is one of the fastest growing career fields in the country; in fact, according to the BLS, the field is growing faster than average and is expected to add over 37,000 new positions by 2020. But while medical billing professionals find positions in distinct environments, they essentially serve the same role regardless of workplace.

What Medical Billing Specialists Do

Medical billers understand medical terminology and are conversant in different medical codes, laws, regulations and policies. They turn coded data into claims to be submitted to different payers (like insurance companies, Medicare and Medicaid), and then continue to follow-up until payment is received or the claim is denied.

Billing professionals also handle patient billing questions, investigate denials, file appeals for patients, establish payment plans and collect on unpaid accounts. They will sometimes work with collection agencies and bankruptcy courts. Many employers require financial reports that medical billers will help compile.

Important Qualities

To excel in medical billing, a person should be detail-oriented and have good record-keeping skills. Medical billers handle sensitive information that in many cases is protected by law, so they have to know how to maintain patient confidentiality. Although actual paperwork will need to be completed, managed and stored, much of today’s work is performed electronically; as such, qualified billing professionals need to be tech savvy to succeed. Understanding how databases work, and being able to anticipate how information should be stored so an authorized person can find it, are qualities sought by employers.

Although different medical billing positions will have unique daily responsibilities, all have the same fundamental duties of submitting claims and collecting payments. Regardless of the work environment, medical billers help keep their organizations running smoothly.

#3: The Role of Medical Billing in the Realm of Healthcare Management

Without regular payments coming in, most healthcare organizations would grind to a halt. Luckily, through the diligent efforts of medical billing professionals, claims are made, bills are paid, and services are provided.

How Billing Works

Absent an emergency, before healthcare service is provided, the patient identifies how payment will be made; if an insurance company, Medicare or Medicaid is liable, someone, often a medical biller, will verify that information.

Next, for each service rendered (or piece of equipment used), a unique code is assigned. Providers or coding specialists record that code in the patient’s records, typically in an electronic database.

Medical billers read that code and translate it into a claim that meets the requirements of the payer (private insurance company, Medicare, Medicaid or the patient). To complete the claim, any of a variety of different forms may need to be prepared and then adhered to. In most situations, electronic claims are submitted and payments are then rendered.

After the claim is approved, payment is usually sent, and when received, it will be recorded and the patient will be billed for any outstanding balance. If the claim is denied, the biller will investigate the reason for the denial, fix the problem and submit an appeal. If, for whatever reason, the patient remains responsible for all or part of a bill, the medical biller may have to contact the patient directly, and even institute collections against him.

To ensure quality and protect against fraud and abuse, medical billers often participate in an auditing process.

With such a vast healthcare system, it would be easy to lose individual claims – along with valuable and necessary payments. Navigating this complex web with electronic record keeping techniques, medical billing professionals ensure patients, physicians and insurance providers each receive the service, payment and information they need to fulfill their roles within the industry.

Additional Resources

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