Medical Billing and Coding

What is a Medical Biller and Coder?

A Medical Biller is responsible for organizing patient medical costs and sending invoices to collect payment from patients and their insurers. This role falls under the umbrella of medical secretaries and administrative assistants and is often an entry level position. Most Medical Billing specialists work full time in hospitals, physicians’ offices, care homes, and other medical facilities, though some may work remotely or part time.

A large portion of Medical Billing and Coding involves acting as a critical liaison between physicians’ offices, patients, and insurance companies. If there’s a problem with an invoice, they’re the individuals who sort it out, but they also do a fair amount of technical work. In a small practice, a Medical Coder may report to the practice’s partners. In larger facilities or hospitals, a Medical Coder may report to a Medical Billing Manager or a Medical Coding Supervisor.

Education Requirements

  • High school diploma or equivalent
  • Certification from the American Academy of Professional Coders (AAPC)
  • 0-2 years experience as a medical billing and coding specialist

Medical Biller and Coder Essential Skills

  • Computer proficiency
  • Strong Interpersonal skills
  • Organizational abilities
  • Knowledge of codes like CPT, ICD-10, and HCPCS
  • Knowledge of medical terminology and basic math

Medical Biller and Coder Roles & Responsibilities

  • Act as a liaison between insurers, medical offices, and patients
  • Handle confidential information and abide by HIPAA laws and other medical policies
  • Conduct audits
  • Perform completion of claims to payers
  • Achieve maximum reimbursement for services provided

Day-to-Day Duties

  • Properly code medical services, diagnosis, treatments, and more
  • Invoice patients and insurance companies for claims or payments
  • Track and collect payments, including setting up payment plans for outstanding bills
  • Correct rejected insurance claims and coding errors
  • Manage patient insurance claims and payment plans
  • Complete Medicare and Medi-Cal reviews
  • Submit billing data to the appropriate insurance providers

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