Medical billing specialists are an integral part of the healthcare system. They provide a bridge between medical providers that diagnose and treat patients, and the insurers who pay for patient care. Medical billing involves reviewing and translating medical records into a universal coding language accepted across the industry. It’s a challenging but rewarding job, having the opportunity to help others without direct patient care.
Medical billers must be detailed oriented, perceptive, and inquisitive because their job requires accurately classifying complex medical information. They must have the independence to process claims and the people skills to communicate with representatives from insurance companies.
Despite the broad scope of the profession, you can enter the field with vocational training that prepares you for the unique challenges of the job. If you’re considering a career in medical billing and coding, a comprehensive training program with a strong curriculum that touches on the clerical duties of a medical biller will position you for success.
What Does a Medical Billing Specialist Do?
Medical billing specialists work in an office and spend most of their time completing tasks on a computer. As a medical biller, you’ll likely work in multiple computer systems to access patient medical records, review charts, input codes, and submit billing. Some of your duties will require phone calls or emails with coworkers or insurance companies to ensure bills are complete, correct, and moving through the insurance system.
Vocational training will prepare you for the various responsibilities you’ll have as a billing specialist. Depending on the size of your employer and their type of practice, you may focus on a few core tasks or be responsible for the entire reimbursement process.
Review Medical Records and Code
Your primary task as a medical billing specialist will be reviewing patients’ charts for relevant medical histories, symptoms, test results, treatments, and diagnoses. You will translate medical records into a list of diagnosis codes that communicate the patient’s condition and the treatments they received.
You’ll then review that information and apply appropriate billing codes, confirm proper documentation is on file to support the codes, and submit claims to insurance companies for reimbursement. Insurers have strict standards on what services they cover, necessary diagnoses, and medical justification. Your job is to obtain the maximum allowable level of reimbursement based on the patient’s treatment.
Audit Records and Verify
Medical billers must adhere to strict standards and ethics. They can only bill for services that were rendered. Your work will often involve reviewing previously submitted bills and cross-referencing for accuracy, completeness, and efficiency. You will need to maintain familiarity with your institution’s policies, revisions to insurance plans, and new legislation affecting Medicare and medical coding.
Invoice Payers and Patients
You may serve as the primary point of contact for insurers and patients who are billed directly. You may need to explain the particulars of an invoice, provide supplemental information to secure reimbursement, and accept payment. You are sometimes required to secure outstanding reimbursement from insurers and patients. Organizational skills and persistence are vital for medical billing specialists because insurance companies have long processing times.
Your job may also require you to respond to denied claims. Insurers can deny reimbursement for many reasons. You will investigate the reason for the denial, assemble a written appeal to the payer, and then submit the bill for reconsideration and repayment. Appeals can involve outside research, obtaining supplemental documentation from the doctor, and composing letters to justify the resubmission.
Ethics and Compliance
As a medical biller, you are obligated to submit accurate claims. You must be discerning about what is billable and only submit claims for services that were provided and documented. It’s your responsibility to maximize reimbursement, but you cannot overstep.
As a medical billing specialist, you must also understand and adhere to the Health Insurance Portability and Accountability Act (HIPAA). This law was created to streamline and standardize the reimbursement process while maintaining the confidentiality and security of sensitive patient data.
What Will I Learn in a Medical Billing Program?
Vocational billing and coding programs are designed to give you fundamental knowledge to perform the job as well as develop the office-based skills you’ll need to succeed.
Programs are a blend of medical and business training. You will learn the medical terminology to understand the clinical aspect of the patient experience. At the same time, you will also familiarize yourself with standard insurance practices.
Electronic Health Records Theory
Legislation passed in 2014 mandated that all medical providers meaningfully use electronic medical records. Medical billers must learn to navigate computer systems that house doctor’s notes, testing and imaging results, medical histories, and treatment plans.
Various proprietary software systems are used across the healthcare industry. However, there are strict standards for what constitutes as a complete medical record. You will learn to understand the nature of medical documentation and record-keeping during your medical billing and coding program.
Understanding Health Insurance Claims
Many private, government-funded, and liability insurances cover patient treatment. They all have strict rules and regulations dictating what services they will cover and which they will deny. You’ll learn the intricacies of the claim process, how to understand insurance plans, and how to correctly bill consistently with these standards.
Medical billing uses the International Classification of Diseases, known as ICD-10, as the universal language between providers and payers. Your training will help you become fluent in this global system. The codes are complex and highly specific. Instructors will teach you the nuances of the system and how to navigate it effectively.
Clinical professionals must be precise, documenting exactly what they diagnose and treat. Medical terminology is vast because it needs to provide detailed information about the human body. Medical professionals learn to read a chart and understand a patient’s condition using prefixes, suffixes and root words. They help you decipher the medical terminology without memorization.
You need fluency and comfort with medical terminology to accurately understand medical records and generate bills that reflect the entire scope of care a patient received.
Physiology for Electronic Health Records
Insurance claims are time-sensitive and particular. Companies can issue denials for late billing and claims that are not justified by the accompanying medical records. You will learn the core principles of anatomy and physiology so you can accurately and efficiently issue bills for services and ensure payment for the medical professionals’ work.
According to the U.S. Bureau of Labor Statistics, the demand for medical billing specialists is expected to grow by 9% over the coming decade. Why? Many private hospitals, government-operated facilities, long-term care residential facilities, clinics, and private practices will all employ medical billers and coders.
Why Seek a Formal Education?
There are many benefits to getting a formal education in medical billing and coding. Some of the more important benefits include:
A Competitive Edge
Although the opportunities for medical billing positions are expected to grow because of expansion in the healthcare sector and expected retirements, there will still be competition for available jobs. A vocational training program will give you an edge over fellow applicants.
Medical billing is a technical field that demands speed and accuracy. Coursework from a specialized program will help you stand out by showing hiring managers that you have solid foundational knowledge about the job.
A Quick Turnaround Time
You can complete a comprehensive training program in as little as nine months, attending full-time. Coursework is rigorous but designed to provide you with the medical knowledge and practical skills needed to succeed in the workplace. The return on your time investment is significant because trained medical billers will have greater opportunities for advancement.
Attending a formal medical billing and coding program will accelerate your career by helping you build a network of fellow professionals. Instructors have industry experience and can offer insight about ways to succeed and avoid potential stumbling blocks. Your education will focus on the real-world application of the skills you learn and bridge the gap between theory and coursework.
Career Services and Networking
Vocational schools measure themselves on job placement. Schools work with students to write engaging resumes and prepare for interview questions. They also provide information on job opportunities. In addition, your instructors can be an invaluable resource for career guidance and understanding of the field.
While nobody can predict swings in the economy, medical billing is a valuable and transferable skill. Without medical billing specialists, healthcare providers would not be able to keep their practice open and facilities would not generate the revenue needed to operate. Learning the principles of medical coding makes you versatile and adaptable, ensuring you can take on a variety of tasks for your employer.
Want to Learn More?
The Medical Billing and Coding training program at Peloton College provides students vital knowledge in Medical Terminology and Understanding Health Insurance Claims and prepares students to be able to work with and maintain electronic health record systems in the health care industry. Graduates of this Medical Billing and Coding training program will also be eligible to sit for the Certified Electronic Health Records Specialist (CEHRS) Certification or the Certified Billing and Coding Specialist (CBCS) Certification.
The mission of Peloton College is to be the premier provider of hands-on training and education by providing students and graduates with the necessary skills to secure occupational careers. Contact us today to learn more.