Medical Billing Specialist
A Medical Billing Specialist is responsible for processing insurance claims, handling billing, and tracking payments in healthcare settings.
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Sample Job Descriptions for Medical Billing Specialist
Below are the some sample job descriptions for the different experience levels, where you can find the summary of the role, required skills, qualifications, and responsibilities.
Junior (0-2 years of experience)
Summary of the Role
We are seeking a detail-oriented and organized Medical Billing Specialist to join our healthcare team. The candidate will be responsible for accurately processing insurance claims, managing patient billing, and following up on unpaid accounts while adhering to industry regulations and guidelines.
Required Skills
- Basic knowledge of ICD-10 and CPT coding
- Proficiency in using Electronic Health Record (EHR) systems
- Good communication and customer service skills
- Basic math and accounting skills
- Competency in MS Office and billing software
Qualifications
- Associate's degree in medical billing, accounting, or related field
- Knowledge of medical terminology and billing software
- Understanding of insurance guidelines and regulations
- Strong attention to detail and accuracy
- Ability to multitask and prioritize work effectively
Responsibilities
- Submit billing data to insurance providers
- Work with medical staff to verify patient information
- Keep records of patient billing and payments
- Follow up on unpaid accounts and resolve billing issues
- Maintain privacy and confidentiality under HIPAA regulations
Intermediate (2-5 years of experience)
Summary of the Role
A Medical Billing Specialist is responsible for handling patient billing, coordinating insurance reimbursement, and ensuring accurate invoicing for healthcare services. This role requires an individual with strong attention to detail, familiarity with medical terminology, and an understanding of billing software and healthcare insurance policies.
Required Skills
- High proficiency in medical billing software.
- Keen attention to detail.
- Good communication and interpersonal skills.
- Ability to multitask and prioritize.
- Working knowledge of medical terminology.
- Proficiency with Microsoft Office Suite and other financial software.
Qualifications
- Associate's degree in a relevant field or equivalent professional experience.
- Certification in medical billing/coding is preferred.
- Strong understanding of medical billing software and electronic medical records.
- In-depth knowledge of insurance policies and procedures.
- Excellent data entry and typing skills.
- Professional attitude and appearance.
Responsibilities
- Process and submit insurance claims in accordance with insurance policy requirements.
- Review patient bills for accuracy and completeness and obtain any missing information.
- Follow up on unpaid claims within standard billing cycle timeframe.
- Check each insurance payment for accuracy and compliance with contract discount.
- Identify and resolve patient billing complaints.
- Prepare, review, and send patient statements.
- Evaluate patient's financial status and establish budget payment plans.
- Contact insurance companies regarding any discrepancy in payments if necessary.
- Maintain strict confidentiality; adhering to all HIPAA guidelines/regulations.
- Update billing software with rate change updates, new procedure codes, etc. as necessary.
Senior (5+ years of experience)
Summary of the Role
As a Senior Medical Billing Specialist, you will be responsible for managing the billing process, ensuring the accuracy of billing data, and providing leadership in the billing department. You will collaborate with healthcare providers, coders, and other staff to facilitate the submission of medical claims to insurance companies and manage patient billing inquiries.
Required Skills
- Advanced knowledge of medical billing processes and regulations.
- Exceptional attention to detail and accuracy.
- Leadership and team management skills.
- Excellent analytical and problem-solving abilities.
- Strong communication and interpersonal skills.
- Ability to multitask and manage time effectively.
- Proficient in the use of industry-standard billing software and tools.
Qualifications
- Bachelor's degree in Health Administration, Finance, or a related field.
- Certification in medical billing/coding from an accredited organization (e.g., AAPC, AHIMA).
- Minimum of 5 years of experience in medical billing or health insurance industry.
- Strong knowledge of CPT, HCPCS, ICD-10, and revenue codes.
- Proficient in medical billing software and electronic health records (EHR) systems.
- Experience with Medicare, Medicaid, and various private insurers' billing regulations and procedures.
- Familiarity with medical terminology and the healthcare revenue cycle.
Responsibilities
- Oversee the preparation, submission, and follow-up of medical claims to insurance companies.
- Ensure accurate coding of diagnoses and procedures in compliance with federal and insurance guidelines.
- Audit billing processes and implement improvements to enhance efficiency and accuracy.
- Manage accounts receivable and resolve issues related to denied or outstanding claims.
- Collaborate with healthcare providers to ensure proper documentation and charge capture.
- Provide training and support to billing staff to ensure adherence to industry standards and regulations.
- Analyze billing metrics and reports to identify trends and areas for improvement.
- Maintain up-to-date knowledge of current billing procedures, payer policies, and regulatory requirements.
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