Your main duty as a medical billing representative or clerk is to generate revenue, collect accounts and maintain invoices for services rendered at a health care facility. Within this broad definition are many moderately difficult clerical duties that you must perform. Attention to detail, general math skills and the ability to effectively resolve customer problems are just some of the qualifications needed for this position.
During invoicing, a billing representative contacts the patient’s insurance company to figure how much of the cost the company will cover. You will calculate the patient’s bill and submit it to the insurance company or the patient for prompt payment. You track invoices and collection activities, maintain cost reports on Medicare bad debts and print aging reports to monitor outstanding balances. Generating, evaluating and sending patient statements is another responsibility. Billing reps also respond to questions from customers and insurance companies and resolve errors and discrepancies.
Collection activities are essential to ensuring that the medical facility gets paid. You may establish payment plans for patients, track payments and follow up when they break the arrangement. You may organize collection activities on delinquent accounts and send the appropriate data to collection agencies. At times, as a billing rep you may have to interview and obtain information from pre-delivery patients and secure payments before delivery. One of your duties is to determine whether to utilize the courts to recover certain payments. You will monitor patient deaths and unpaid balances to initiate claims against estates. Another task may be to maintain financial records on government and third-party insurance and patient billing.
Medical billing representatives work in various health care environments. This includes hospitals, insurance and home health agencies, consulting firms, government agencies, long-term care facilities and outpatient clinics. Regardless of the environment, you are expected to follow company standards and maintain regulatory compliance, such as the Health Insurance Portability and Accountability Act of 1966, which relates to confidentiality.
Educational requirements vary by employer and the scope of your duties. Some employers are satisfied with a high school diploma and prior billing and collections experience. Others prefer candidates with some college coursework or an associate degree in accounting or business. General knowledge of the laws affecting medical insurance billing may be preferred. To stay current on the latest computer software that is generally used in this job, continuing education is sometimes necessary. To work for a public health department, you may have to pass a civil service examination.
Physician offices have the highest level of employment for billing and posting clerks, paying a mean hourly wage of $16.42, as of May 2012, says the Bureau of Labor Statistics. General medical and surgical hospitals have the second highest rate of employment, paying a mean hourly wage of $16.52.
Grace Ferguson has been writing professionally since 2009. With 10 years of experience in employee benefits and payroll administration, Ferguson has written extensively on topics relating to employment and finance. A research writer as well, she has been published in The Sage Encyclopedia and Mission Bell Media.