General Summary of Duties

A medical biller is in charge of calculating and collecting payments for medical procedures and services. Their work includes updating patient data and preparing invoices. They work in medical administrative offices to ensure that patients are billed quickly and accurately. They are responsible for submitting medical claims to insurance companies and payers such as Medicare and Medicaid (or any other insurance companies).

Education and Experience

• At least a high diploma/Bachelor's Degree in Business, Health Care Administration, Accounting or relevant field;
• A minimum of three years of experience in a medical office setting as a Medical Biller or related role;
• Solid understanding of medical billing software and electronic medical records (EMR);
• Have an advanced experience in using MDI and exposure in the field of medicine;

Major Responsibilities/Tasks

• Prepare and submit billing data and medical claims to insurance companies;
• Interacts with patients regarding medical claims and payments, including communicating with patients and family members of diverse ages and backgrounds.
• Ensure the patient’s medical information is accurate and up to date;
• Prepare bills and invoices, and document amounts due for medical procedures and services;
• Collect and review referrals and pre-authorizations;
• Monitor and record late payments;
• Follow-up on missed payments and resolve financial discrepancies;
• Examine patients bills for accuracy and request any mission information;
• Investigate and appeal denied claims;
• Help patients develop patient payment plans;
• Maintain billing software by updating rate changes, cash spreadsheets, and current collection reports;
• Ability to work well in a team environment. Being able to triage priorities, delegate tasks if needed, and handle conflict in a reasonable fashion.
• Maintaining patient confidentiality as per the appropriate policies.

Knowledge and Skills

Must demonstrate current competencies applicable to the job position such as:

• Knowledge of insurance guidelines including HMO/PPO, Medicare, Medicaid, and other payer requirements and systems;
• Competent use of computer systems, applicable softwares, and 10 key calculators;
• Familiarity with CPT and ICD-10 Coding;
• Problem-solving skills to research and resolve discrepancies, denials, appeals, collections.
• Knowledge of accounting and bookkeeping procedures.
• Knowledge of medical terminology likely to be encountered in medical claims.
• Ability to multitask.
• Must have excellent interpersonal/communication skills
• Must be able to work as part of a team if need be;
• Ability to work with little or no supervision;
• Ability to pay attention to details;
• Technical and clinical skills across the healthcare industry;