What Does a Billing Specialist Need to Know?

What Does a Billing Specialist Need to Know?

Health Insurance

A medical coding and billing specialist works in a medical office and one of their tasks is to liaise with insurance companies to ensure prompt and correct payment. It is the job of the coding and billing specialist to, among other things, manage insurance claim forms, raise invoices, and chase payments. Sometimes a medical office will have a medical coder and a billing specialist, while in other facilities the role will be combined. 

Duties of the Medical Billing Specialist

The day-to-day duties of a medical coding and billing specialist include: 

  • matching diagnoses, medical treatments, and administration tasks with the correct medical billing codes, always ensuring HIPAA compliance
  • creating invoices to be sent to the relevant insurance company
  • sending claims for payment
  • checking rejected claim forms and correcting any mistakes therein
  • chasing payments with insurance companies and patients. 

How Much do Medical Billing Specialists Earn? 

The average salary for a medical billing specialist in the United States is currently $43,565. The actual salary an individual will be paid very much depends on factors such as geographic location, education, qualifications, and experience in the profession. Most medical billing specialists will earn between $40,543 and $47,637. 

How to Become a Medical Billing Specialist

Although medical billing specialists work in the healthcare sector, the role is primarily an administrative one, meaning that the road to qualification is often quicker and easier than for other jobs in the industry. 

There are some employers who will hire their coders and billing specialists with a high school diploma as they will provide on-the-job training. However, many prefer their potential employees to have some kind of certification. In many cases, those with an associate or bachelor’s degree in a healthcare field will have an advantage over someone applying straight from high school. 

There are a number of courses designed specifically for medical coding and billing specialists. Certifications in these would be a definite advantage: 

  • CPC – Certified Professional Coder
  • CPB – Certified Professional Biller
  • CCA – Certified Coding Associate
  • CCS – Certified Coding Specialist
  • RHIT – Registered Health Information Technician.

What Will a Medical Coding and Billing Specialist Have to Know? 

This job requires an affinity for records and numbers, so if this is you then you are likely to love what you do. According to Find-A-Code.com, there are hundreds of thousands of codes used in the medical industry, and while you will not be expected to learn them all, there will be some that you will use more often than others. You will also need to learn the different types of codes used. These include:

  • ICD – International Classification of Diseases
  • CPT – Current Procedural Terminology
  • HCPCS – Healthcare Common Procedure Coding System
  • DRG – Diagnostic-Related Group
  • NDC – National Drug Code
  • ICF – International Classification of Functioning, Disability and Health
  • DSM – Diagnostic and Statistical Manual of Mental Disorders.

On a day-to-day basis, coders and billing specialists will likely use databases to find the code that relates to the information in the claim they are processing. There are unique codes for every task and service that a medical facility provides. The codes on a claim form will instruct the insurance company on how much money to pay the medical facility. All healthcare facilities and insurance companies use the exact same codes for services and tasks.

Healthcare professionals document a patient’s visit in their record, and this is then passed to the medical coding and billing specialist who will find the relevant alphanumeric code for each specific task at hand. This requires a general knowledge of physiology, anatomy, and the policies and rules of the insurance company in question.

Source: https://www.salary.com/research/salary/benchmark/medical-billing-specialist-salary#:~:text=How%20much%20does%20a%20Medical,falls%20between%20%2440%2C543%20and%20%2447%2C637

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