What Are the Duties of a Medical Billing Specialist in a Large Group Practice?

Medical billing specialists are essential to the health care industry.
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Medical billing specialists fill a crucial role in the treatment of patients -- they're responsible for payment. Being a billing specialist is a great way to be a part of the health care industry for those who don't want direct contact with patients. You need to be detail oriented and organized and complete some training before you can be hired, but once you're qualified to work as a billing specialist, you can work in large practices at their office or sometimes even from home.

Determine Diagnosis and Treatment Codes

When a patient goes to the doctor, there are specific codes that tell the insurance company what illness or injury they have. These codes are called ICD-9 codes, which stands for International Classification of Diseases, 9th edition, the handbook used by medical professionals everywhere. Starting Oct. 1, 2014, these codes will be replaced by the ICD-10 codes, as the new edition of the handbook takes effect. The proper codes are crucial, because many insurance companies have some diagnosis that they do not cover. Once the diagnosis is properly coded, the billing expert has to choose the appropriate treatment code, referred to as a CPT code. This acronym stands for current procedural terminology, and a new edition of these codes comes out each year. If the CPT is incorrect, the insurance company will reject the bill.

Submit Bills to Insurance Companies

Once the correct ICD-9 and CPT codes are listed for the patient's visit, the billing specialist can get ready to bill the insurance company. She must enter the patient's information into the computer, including their name, Social Security number, date of birth, address, insurance information and diagnosis and treatment codes. Many insurance companies accept electronic billing now, which allows the billing specialist to send the bill easily once that information has been entered. One of the things that billing specialists do is keep track of when the patient was seen and when the insurance company was billed, because in many cases the insurance companies will not pay if the bill is submitted too long after the patient's visit.

Handle Appeals and Corrections

No matter how good a billing specialist is, there are going to be times when the insurance company will reject a bill. Sometimes it's as simple as a typo on a CPT or ICD-9 code, but other times there might be questions about the exact nature of the patient's diagnosis or the treatment he received. The billing specialist is the one that has to handle these issues. She must find the problem, look for a solution, and then resubmit the bill, all in a limited time frame.

Handle Patient Billing and Issues

Patient payments are also part of the billing specialist's job description. Many patients have a co-pay or a deductible that gets taken off the amount billed to their insurance, and the billing specialist is responsible for collecting that amount and making sure it is applied to the correct bill. Many times, especially if a patient has no insurance and pays cash, the patient might have a question about the bill. It is the billing specialist's job to talk to the patient and explain the bill to him.

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