How to become A Medical Biller

Attention to detail is one of the critical skills that healthcare professionals share in common. Medical Billers, enthusiastic in their pursuit of easing healthcare procedures for patients, use their experience with electronic and paper billing systems to pay meticulous attention to process, submit and follow up on insurance claims, facilitating the receipt of payments for healthcare services. 

• Medical Records Technician
• Medical Records Clerk
• Medical Records Coordinator
• Medical Records Tech
• MRT

What do Medical Billers do?

 A Medical Biller would typically need to:

• Record, organise and update clinical data electronically for storage, collection, analysis, retrieval and reporting in the form of databases and registries; maintain the confidentiality of the records
• Use classification systems to assign codes for patient data analysis and insurance reimbursement
• Review patients’ records and bills, both electronic and paper, for completeness and accuracy; ensure that they meet deadlines and that missing information is collected; confirm the accuracy of payments
• Prepare, revise and transmit claims using billing software for accuracy 
• Create payment plans for patients; deal with unpaid claims and delinquent accounts; collect remainder payments within the standard billing cycle timeframe
• Obtain insurance referrals and pre-authorisations as per hospital and state regulations for patients
• Verify insurance eligibility and benefits for treatments, hospitalisations and procedures
• Check and recheck every insurance payment; appeal for denied claims after exhaustive research
• Update cash spreadsheets; run collection reports 
• Submit claims to insurance firms for auditing of patient procedures and treatments
• Answer phone inquiries from both patients and insurance firms in the context of accounts
• Employ Fair Debt Collection practices

Medical Billers typically work with computers and telephones, entering codes and processing billing information. They may spend time in an office environment at a healthcare facility or in a separate venue or work from home, depending on their employer’s needs.

Medical Billers work full time from 9 a.m to 5 p.m, typically 40 hours a week. However, if you work for healthcare facilities open round the clock, you may need to cover shifts overnight, during weekends or vacations.

Finding a new job might seem challenging. Medical Billers can boost their job search by asking their network for referrals, contacting companies directly, using job search platforms, going to job fairs and inquiring at staffing agencies. You may work for healthcare information management companies that provide contractual services to clients to manage their accounts. 

Medical Billers are generally employed by:

• Hospitals
• Physician’s Offices
• Healthcare Information Management Companies
• Administrative Support Services
• Management of Companies
• Nursing Homes 
• Outpatient Facilities
• At-Home Healthcare Services
• Professional, Scientific & Technical Services

Healthcare associations provide unparalleled networking and educational opportunities for Medical Billers. They offer all the certification courses members will need throughout their professional careers. You may attend conventions, seminars, and dinners frequented by peers, mentors, and other industry leaders. The events help them keep up with the newest breakthroughs and latest developments in the field, including plum jobs. 

• Maintaining concentration and attention to detail and building experience with handling electronic and paper healthcare records attention to detail and experience with the electronic and paper systems 
• Difficulties involved in settling any confusion regarding insurance policies
• Inconveniences such as rejection from insurance firms or problems with patients’ payments and insurance policies can be frustrating
• Risks involved in the leakage of confidential patient health information
• Exposure to infectious diseases and hazards while being in direct contact with patients
• Work delays caused by a disruption in technology; lack of training and knowledge in using the systems
• Growth of non-traditional healthcare structures like telehealth that can replace the existing healthcare infrastructure
• A lack of balance between personal and professional life; no time for self-care due to long working hours can lead to frustration and burnouts
• Fatigue and other health issues due to reasons such as long periods of standing; eye strain caused by long hours at the computer

Academic programs that Medical Billers take up may involve supervised experience. Work experience from any paid or unpaid internships or placements in clinical settings, such as a local hospital, doctor's surgery, nursing home, or mental health trust, will help them understand some of the demands of a career related to medicine. You will also develop skills such as attention to detail, communication and reliability. 

Teaching hospitals offer work experience in various departments, especially for high school students who aspire to become Medical Billers. Healthcare apprenticeships also offer adequate experience for you to land a job as a Medical Biller.

Read about the profession and interview or job shadow experts working in Medical Billing to prove your commitment to course providers and prospective employers.

Entry-level Medical Billing positions require a minimum of a high school diploma or equivalent paired with prior experience in the healthcare industry.

However, some employers prefer to hire candidates with postsecondary qualifications, such as a certificate or degree in health information or medical record technology or health informatics, for more advanced positions. Degree programs cover essential technical knowledge of diverse topics, such as claims processing, medical terminology, healthcare data, anatomy, physiology & pathophysiology, healthcare claim cycles, medical law & ethics, business administration and accounting processes.

You will also learn about various healthcare settings, computers, healthcare communication, billing application, and records management. A combination of such courses will give you a competitive edge in the job market.

A degree in business administration, accounting, or healthcare administration will help you develop knowledge of business and accounting processes.

You may increase your chances of admission into college programs by taking high school classes in biology, mathematics, health and computer science.

Employers prefer to hire Medical Billers who have received certification or expect employees to acquire it once they join work. Some prominent certifications include the Certified Professional Biller, which demonstrates your proficiencies in medical billing, reimbursement, submitting appeals, posting payments and following up on outstanding fees, thus ensuring the smooth running of the financial operations of the medical facility.

Most certifications require you to pass an exam, while some may even mandate graduation from an accredited program or work experience in coding. Renewal and continuing education are necessary for all certified Medical Billers.

Performance, experience, and the acquisition of professional qualifications drive career progression. Employees with consistently high levels of performance may be eligible for promotion every two to three years.

After completing certification, a bachelor’s program, or a master’s degree in health information technology, Medical Billers may advance to Medical or Health Service Manager positions. You may also take on the roles of Compliance Auditors or Reviewers. 

Completing nursing assistant courses and acquiring certification could help you take up a job as Nursing Assistant. Those who pursue higher studies and obtain relevant certification in nursing may be promoted to more skilled healthcare positions such as Registered Nurse, Physician Assistant or Nurse Practitioner. 

You may also switch over to allied positions in the healthcare industry, such as Data Operator, after completing the required computer courses and certification.

With adequate experience, you may take up consultancy or work freelance.

Candidates with certifications in health technology and familiarity with electronic health records have the best job prospects.

Continuing professional development (CPD) is essential in the healthcare sector for public wellbeing and career progression. It embraces several new learning objectives, educational methodologies, and novel technological developments, especially in education, management, and IT.

After recruitment, you will continue to learn how to code paper and electronic health records and record patient information for a few months, under the supervision of senior employees. As a newly hired Medical Biller, your initial training will help you adapt to the specific billing software and practices that your employer uses, familiarise you with what the patients need and the position of outstanding claims and invoices currently.

Medical Billers with only a high school diploma may consider completing a postsecondary degree in health information technology or other relevant fields to understand medical codes, terminology, insurance policies, regulations and other concepts. 

Consider attending workshops or seminars to learn how to use medical billing software, create documents and invoices, organise and analyse spreadsheet data and other computer-associated tasks.

Remember to remain up to date with your continuing education credits to ensure the validity of any license or certificate you may have acquired. 

History

Medical billing was carried out on paper for several decades. The advent of medical practice management software, also known as health information systems, led to the efficient management of many claims. The rise of the software industry has catered to this need by providing medical billing software, thus creating a lucrative and profitable niche market. Companies often offer complete portal solutions through their own web interfaces, thus reducing the cost of individually licensed software packages. 

The Process

Medical Billers face the responsibility not only of data collection and insurance claim submission but also of ensuring data accuracy and appropriate claim adjudication. Their work includes posting payments from either the patient or the insurance firm to the claim. The remaining fees are then written off, adjusted or followed up in collections.

A Medical Biller must follow the prescribed steps for every healthcare transaction. Typically, you must gather several types of data to place on the relevant forms, whether physician billing or hospital billing. Firstly, you must ensure that patient demographic information, such as name, date of birth, address, and insurance details, are filled in correctly. Make sure to include medical data such as the date of injury and the physician’s diagnosis based on a code from the ICD (International Classification of Disease) Coding Book. The third category of data pertains to the medical services rendered and the payments charged for them. Services rendered are reported using the relevant codes prescribed in the location where you work.

Integrating medical billing software with electronic health record systems offers digital payment processing and prompt payment reminders for patients. 

The medical billing industry is becoming infused with technology, with electronic records taking over paperwork. Even with such changes, Medical Billers continue to exercise their sophisticated and impeccable attention to detail, paired with an empathetic and pragmatic approach to the patients they assist from a distance. Even without joining medical school, you are part of the complex healthcare system that provides the best possible care to patients. It is a rewarding job in more ways than one.

Hone your attention span and sense of perfection to ensure the best care for your patients and their clients.