A Medical Biller manages the submission of accurate claims to insurance companies to ensure timely reimbursement for healthcare services. They verify patient information, code medical procedures, and follow up on unpaid claims to maximize revenue for the healthcare company. Their role is essential in maintaining the financial stability and compliance of the healthcare practice.
Verify patient insurance eligibility and benefits
Verify patient insurance eligibility and benefits by accurately reviewing insurance plans and coverage details to ensure proper billing and minimize claim denials. Utilize healthcare payer portals and systems to confirm patient information, coverage dates, and authorized services. Maintain up-to-date knowledge of insurance policies and collaborate with billing teams to optimize revenue cycle management.
Prepare and submit insurance claims
Prepare and submit insurance claims by accurately gathering all necessary documentation and verifying policy details to ensure timely processing. Maintain clear communication with clients and insurance providers to resolve any discrepancies or additional information requests efficiently. Utilize claims management software to streamline submissions and track claim statuses effectively.
Review and code medical procedures and diagnoses
Accurately reviewing and coding medical procedures and diagnoses requires expertise in ICD-10-CM and CPT coding systems to ensure compliance with healthcare regulations and proper billing. Proficiency in medical terminology, anatomy, and healthcare documentation is essential to support clinical accuracy and reimbursement processes. Utilize electronic health records (EHR) software and regularly update coding knowledge to maintain up-to-date coding standards and reduce claim denials.
Resolve claim denials and rejections
Efficiently resolve claim denials and rejections by analyzing denial reasons, verifying patient information, and collaborating with insurance providers to ensure accurate reimbursement. Utilize claims management systems to track and document all correspondence and actions taken for each claim. Implement proactive strategies to reduce future denials and improve overall revenue cycle performance.
Post insurance and patient payments
Posting insurance and patient payments requires accurate data entry to ensure claim reconciliation and account balance updates. Proficiency in medical billing software and understanding of insurance remittance advice enhances payment posting efficiency. Attention to detail is critical for identifying discrepancies and collaborating with billing teams to resolve payment issues promptly.
Generate patient billing statements
Generate patient billing statements by accurately compiling charges, payments, and adjustments to maintain clear financial records. Ensure statements are clear and detailed to facilitate prompt patient payments and reduce billing inquiries. Collaborate with medical and administrative staff to resolve discrepancies and update patient accounts efficiently.
Track and follow up on unpaid claims
Efficiently track and follow up on unpaid claims to ensure timely reimbursement and maintain cash flow stability. Monitor claim statuses through the relevant billing software and communicate proactively with insurance providers to resolve discrepancies. Implement systematic documentation and reporting to improve claim recovery rates and reduce outstanding accounts receivable.
Maintain accurate billing records and documentation
Maintain accurate billing records and documentation to ensure timely invoicing and effective revenue tracking. Utilize accounting software and billing systems to record transactions, verify client information, and resolve discrepancies promptly. Develop strong organizational skills and attention to detail to support financial reporting and compliance requirements.
Communicate with insurance companies for claim clarification
Effectively communicate with insurance companies to obtain claim clarifications, ensuring accurate and timely resolution of inquiries. Collaborate with claims adjusters and underwriters to verify policy details, coverage limits, and claim statuses, facilitating streamlined processing. Utilize strong interpersonal and documentation skills to maintain clear records and support efficient claims management.
Ensure compliance with billing regulations and HIPAA
Ensure strict adherence to HIPAA regulations and billing compliance standards by accurately processing claims and maintaining secure patient data confidentiality. Implement routine audits and training programs to prevent credentialing errors and minimize financial risk. Collaborate with legal and audit teams to update policies reflecting the latest healthcare laws and billing practices.