What are careers in medical billing?

Medical billers, medical records technicians, and billing analysts are careers in medical billing.

• Medical Biller

A medical biller is someone who submits a coded transcript that contains a summary of a patient's visit to their insurance company to file a claim.

They work directly with medical coders who create the medical coding for them to translate using specialty software so that it can be sent to the insurance company for review. They act as a liaison between insurance companies, healthcare providers, and patients, so they typically have a lot of knowledge of both insurance and healthcare.

Billers first collect the necessary information. This includes patient demographics, medical history, insurance coverage, and what services or procedures the patient received. Gathering this information requires billers to review patients' medical charts and insurance plans to verify coverage of services.

They then generate medical claims, check for accuracy, and submit claims to payers. Once payers approve the claims, the claims are returned to billers with the amount payers agreed to pay. At this point, or before patients see the doctor, billers prepare the patient's bill.

This involves deducting the amount covered by insurance from the cost of the procedure or service, factoring in copays and deductibles, and adding outstanding patient balances. Invoices are sent to patients when required and payments are posted and reconciled.

Medical billers may work as front-end billers or as back-end billers. Front-end billing takes place before the patient's services are done. This role usually works with the front-office staff and is patient-facing (e.g, copays). Back-end billing occurs after the provider has seen the patient.

Back-end billing staff are more focused on the requirements for claims management and reimbursement. There is a higher level of complexity with back-end billing because simple errors can inflate claim denial rates.

• Medical Records Technician

Another role in medical billing is a career as a medical records technician. A medical records technician is responsible for ensuring that a patient's medical records are accurate so that a medical coder can use them to create coding used for insurance claims.

They track and update a patient's medical history, past claims, treatments, and other confidential information so that healthcare providers and their patients can receive the appropriate reimbursement from insurance carriers. Medical records technicians may also transcribe these records into code based on acceptable coding guidelines.

A medical records technician needs to be highly analytical, technical, and organized as the accuracy and quality of their recorded data is pertinent for insurance company reimbursements for services rendered to the patients from the provider. Technicians will generally work at a computer for long periods.

In most cases, technicians work in hospital settings where the facilities are open 24/7, so technicians may be required to work evenings, overnight shifts, and holidays.

• Billing Analyst

Billing analysts are responsible for reviewing invoices and correcting any discrepancies, which may include seeking clarification from other departments or an insurance carrier. They also evaluate existing billing procedures and software and provide feedback to management on ways to improve them.

A billing analyst will work in collaboration with the accounting and finance departments to answer customer questions about their bill, review billing statements, or correct billing errors. Depending on the size and nature of the organization, they may also be involved in invoicing customers, although most organizations will automate that process.