Medical billers are the professionals responsible for the cash flow of a medical practice. They are knowledgeable about insurance regulations, health insurance contracts, medical coding, and bookkeeping. Medical billers spend much of their work day on the computer and the telephone. Medical billing is the act of communicating with third party payers what services were provided to patients, and why. A professional medical biller also discusses bills with patients and explains their insurance benefits after the claim has been processed by the insurer. A professional medical biller is trained with a specialized skill set that is valued by employers in the healthcare industry.

It is possible to enter the field with minimal training, but as the business of healthcare and healthcare reimbursement becomes more sophisticated, more and more, employers are looking for medical billers who have received formal training. The U.S. Bureau of Labor Statistics lists medical billing as a field with almost unlimited growth potential. It is no surprise that people are considering a career change to join this lucrative profession.

Attention to detail is the primary skill of a successful medical biller. Medical information is transmitted in the form of industry-standardized codes. A patient’s medical record is translated into codes defined by the Centers for Medicare and Medicaid Services (CMS), a federal body that oversees the broad outlines of medical coding protocols, as well as administering the federal Medicare program. Medical billers need to be conversant in the guidelines governing the Healthcare Common Procedural Coding System (HCPCS), which includes the Current Procedural Terminology (CPT) published by the American Medical Association, as well as diagnosis coding found in the International Classification of Diseases-9th Edition-Clinical Modification (ICD-9-CM).

With a sound grounding in coding, a medical biller assembles data in a way that conforms to the contractual requirements that a healthcare facility agrees to in order to receive payment for services. When a claim is assembled correctly, payment is made in a timely manner. Much of the work that a medical biller performs is computerized. Paper healthcare claims are still used, but the majority of healthcare claims are transmitted and paid electronically. Medical billing requires basic computer literacy, and being able to master specific software programs. Much of a medical biller’s day is made up data entry, and of verifying that the data is correct prior to claim submission.

As the point person between providing services and receiving payment, medical billers need to submit claims in the correct format the first time, in order to ensure that payment is received when it is expected. When claims are denied because of data entry errors, the medical biller is at fault, and the employer suffers from the lack of cash when expected. The most important thing a medical biller can do is submit clean claims that guarantee timely reimbursement.

Medical billing can be taught on the job, but, more and more, employers are looking for qualified candidates to fill medical billing positions. Submitting clean claims is vital to the business of a healthcare facility, whether it is billing for a doctor’s office, billing for a hospital, billing for a skilled nursing facility, or billing for an outpatient surgical center. Formal training, followed by an earned certification, is proof that a medical billing candidate has mastered the basics, and will be able to positively impact cash flow. It all boils down to what will help the financial bottom line. People who have invested the time and effort to master the subject matter are more attractive to employers than someone without any background in medical billing and medical coding.

Each insurer, including Medicare, Medicaid, and Tricare, requires data to be submitted in a set format to receive proper reimbursement. Medical billers need to be able to research insurance contracts and regulations in order to submit healthcare claims that are accurate and in compliance with applicable laws and contractual obligations. Medical billing is not the primary concern of healthcare providers who are more focussed on providing care. They rely on the experience of professional, trained medical billers to handle the business end of healthcare administration.

Most medical billers are certified by a professional organization. Some of these include the American Academy of Professional Coders (AAPC) and the American Health Information Management Association (AHIMA), as well as the American Medical Billing Association (AMBA) and the Medical Association of Billers (MAB). Some programs are more respected in the industry than others. People looking into medical billing training should research their options before deciding on a program of study.

Many community colleges offer courses and degrees in medical billing. Private schools that specialize in medical careers often offer medical billing certificate programs. Online courses are available that allow students to work independently, according to their own schedules, to learn more about this specialized profession. Any investment in medical billing education is money well spent.

Patience, practice, and mastery of the information involved, are the hallmarks of a successful medical biller. Medical billers often work in solitude, with a computer and a telephone. They discuss issues with physicians, and other healthcare providers, but the bulk of their time is spent managing and manipulating data.

A successful medical biller does more than send patients medical bills. He or she ensures that patients receive the insurance benefits they deserve. By properly submitting medical claims as accurately as they can, medical billers guarantee cash flow for their employers, while also guaranteeing that patients are not responsible for more than is reasonable, according to their insurance contract.

Medical billers spend many hours on the telephone, either discussing specific claims with insurers, or discussing patient bills with those responsible for the charges incurred. A medical biller must be open to whatever a health insurance company or government healthcare program is telling him or her about a single claim, and be able to apply that knowledge to all claims to gather the maximum, legal reimbursement. He or she must also be able to explain insurance decisions to individual patients so that they understand why they are responsible for deductibles, co-insurance, and co-payments, as well as non-covered medical services.

Every medical service has a dollar amount attached to it. Medical services cannot be provided without payment if the healthcare institution is going to stay in business. A professional medical biller knows what services are reimbursable, and which ones will be the patient’s obligation. Being able to communicate effectively with patients to recoup unpaid balances is a medical biller’s specialty, maintaining goodwill between patient and provider within legal and professional guidelines.

With a solid education in the issues involved, successful medical billers are valued members of the healthcare delivery team that are well-paid for the performance of their duties. According to the Bureau of Labor Statistics, medical billers earn more than other administrative healthcare professionals. With their training, medical billers make the business operations of healthcare delivery run smoothly and efficiently.