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Being a Certified Medical Biller can be both challenging and rewarding. It’s a unique career opportunity that combines medical terminologies with insurance and billing techniques. If you enjoy detective work and putting the pieces of a puzzle together, this is without a doubt a career path you could enjoy. This article gives you a behind-the-scenes look at what a medical biller’s life is like the sort of tasks you can expect to perform daily, and how these tasks are completed.

What is the Role of a Medical Biller? 

Before delving into what the life of a medical biller looks like, it would be best to examine what this career path entails.

Medical billers work with the codes provided by medical coders. They take these codes and ensure that they are submitted correctly to the insurance company for reimbursement. The tenet of the profession are the reconciliation of all billable services, updating those services on a claim form, and timely submission to the insurance provider.

A Typical Workday for a Medical Biller

typical day for medical billerNow that you have a general outlook of what a medical biller does let’s outline what a typical day in the life of a medical biller will look like.

Once you arrive at your workstation, your workday will begin with logging onto your computer and the various programs you will need to perform your job. Typically, you will have a company email account, access to one or more databases, and possibly software programs that you will work with while dispensing your duties.

Once powered up, you will then check for updated patient charts. This requires that you check on the previous day’s logs so that you can prepare charts for data abstraction and coding. Based on the training provided to you, you will then prioritize which of these charts you will be working on first.

Medical Billing and Coding Tasks

What we typically see in large practices is that different employers assign different types of medical billing and coding tasks to their employees. What this could look like for you while working at such an establishment may vary.  You might be put solely in charge of inpatient surgeries, or you might work with the auditor to validate the coding accuracy.

Of course, this might not apply for a small practice as you will likely end up being in charge of processing all the patient charts. Regardless of the specific role you undertake as a medical biller, it would be best if you were knowledgeable on multiple coding systems and have proper training when it comes to dealing with insurance companies.

In the early afternoon, you will have already selected what charts you will be prioritizing. The rest of the day is typically spent carrying out a variety of coding tasks. On top of assigning codes, you will likely be required to review medical charts, take notes, and assist when it comes to claims submission. Because preparing claims is what you will spend most of your time doing, it would be best if you set up a system that assists you with your efficiency and productivity.

For instance, while carrying out these tasks, you are likely going to interact with tens of thousands of medical codes. Thankfully, employers do not expect that you commit all of these to memory. Still, we see instances where employers expect that their employees have a pretty good understanding of charts that they may deal with on a daily basis. As such, consider creating a coding and charting system that works best for you. This comes in handy as most workplaces will have predefined milestones, specifically as it pertains to the number of charts you can complete each day.

Insurance Verification

Once you finish pulling the various data, you then have to verify the patient’s insurance benefits and payment policy for the services provided. This should ensure that the claim goes out clean. A clean insurance claim is swiftly paid within a maximum of 15 working days.

After the verification, you will then enter the new claim into the billing database system. If the employer works with an electronic claim vendor, you will then check if any of the previous claims you entered have been rejected. In case of an issue, you should promptly resolve any rejected claims and resubmit it to the insurance company before the claims filing deadline. Finally, you might be expected to pull down any electronic remittance from the vendor’s site as these payments are often posted along with checks that will be coming in on the same day through regular mail.

Processing Payments as a Medical Biller

medical biller performing daily tasksIn the event that there are payments made, you will embark on carefully reviewing each payment. Thereafter, you will be expected to post these payments, any adjustments, and patient portions to the accounts. It is at this point that you might consider flagging any appeals. This involves carefully reviewing the flagged items with the payment policy so that you can show the insured that the claim was paid correctly. If the claim was paid incorrectly, you would then prepare an appeal and send it to the insurance company. If all the payments are applied and appeals sent, you will then file each away in its proper place subject to your training.

Follow-Ups Can Be Critical for Claims

A task that you will often be called upon to perform is following up. To make this easier, consider setting up a daily to-do file that you could easily pull up and review everything that needs a follow-up. The idea behind the follow-up is to ensure that no claim slips through the crack and causes a financial loss to the organization, patient, or the firm you work for.

Finally, it’s time to check your message board. This is often where patients will reach out concerning the most recent statement you sent them or where coworkers will reach out concerning the files you are working on. 

Once all your tasks are done for the day, you will then clean up your workspace subject to your training. This typically looks like pulling any tasks to the top of the pile of what must be done the next day in the morning or distributing any communication that remained on the outbox folder to its intended recipient.

CBS Medical Billing Is Hiring Medical Billers Like You

Overall, a medical biller will typically work 40 hours per week, with a lot of time spent in front of a computer entering codes and processing billing information. As such, you want to be part of a team that not only cares about you but also values you as an employee. It is in light of this that we invite you to join the ever-growing all-star team at CBS Medical Billing and Consulting, LLC. Contact us today, and let’s discuss how you can be an invaluable member of our team.