Medical billing and coding are both in-demand jobs these days. Today, however, we are going to particularly focus on how to become a medical billing specialist.
Medical billing and coding is a constantly increasing industry. Over the years, the demands for both medical billers and coders have never declined, and there is no sign of slowing down at all.
In fact, according to the United States Bureau of Labor Statistics, as of 2019, medical records and health information technicians — the job category where medical billers and coders belong — is comprised of 341,600 employees.
More so, experts project that between 2019 and 2029, there would be an 8% increase (which is much faster than the average job outlook) in the employment rate in this industry.
The rise is expected especially since the health industry is constantly evolving and adapting to changes particularly technology-wise.
Both medical coding and billing are an essential part of the healthcare industry. They are actually considered the backbone of the healthcare industry.
As you probably know, medical billing and coding are two different things. They are two different processes that play a very important role in the healthcare industry.
Today, however, as we have mentioned earlier, we are going to particularly focus on medical billing specialists.
If you are someone who’s eyeing to enter into this field, this one’s perfect for you.
In the following sections, we are going to particularly tackle the following:
- What is a medical billing specialist?
- What does a medical billing specialist do?
- How to become a medical billing specialist?
- How much does a medical billing specialist make?
WHAT IS A MEDICAL BILLING SPECIALIST?
First of all, before we even talk about the more detailed information about this job, let us define what a medical billing specialist is all about.
More popularly known as a medical biller, a medical billing specialist is someone who is responsible for submitting medical claims to insurance companies as well as payers like Medicaid and Medicare.
As mentioned earlier, alongside medical coders, medical billers play a very important role particularly for the financial cycle of all healthcare providers — whether it be single-provider practices or large medical centers.
Essentially, a medical billing specialist is someone who ensures timely submission of technical or professional medical claims to insurance companies and payers.
Usually, people perceive them to be working in a hospital setting, but in reality, medical billers may work not only in hospitals but also in physician offices, clinics, nursing homes, as well as other healthcare facilities.
Meanwhile, if you want to know more about medical billing, check out the very informative video below by All Things Medical Billing:
WHAT DOES A MEDICAL BILLING SPECIALIST DO?
As someone eyeing for the job, it is also equally important that you fully know and understand the demands of the job.
You have to be prepared for the tasks before you even get yourself into it.
So, what does a medical billing specialist do?
To be upfront, specific duties, as well as the amount of time you will spend doing all these, depends on one work setting to another. Remember, as mentioned earlier, a medical biller works in different settings — could be in a doctor’s office, in a hospital, etc.
So, for every work setting, there is a specific job requirement.
However, in most cases, as a medical biller, you are expected to do the following duties:
- Check eligibility as well as benefits verification for procedures, treatments, and hospitalization.
- Obtain pre-authorizations and referrals based on the requirements set for certain procedures.
- Review patient bills and ensure accuracy and completeness, as well as obtain missing information should there be any.
- Prepare, review, and transmit claims using medical billing software. This process includes both electronic and paper claim processing.
- Check all insurance payments for accuracy and compliance with contract discounts.
- Follow up any unpaid claims within the standard billing cycle timeframe.
- Identify and bill secondary or tertiary insurances.
- Call insurance companies and settle any discrepancy in payments should there be any.
- Research and appeal denied claims.
- Review accounts for insurance of patient follow-up.
- Set up patient payment plans as well as work collection accounts.
- Answer all patient or insurance phone inquiries regarding the assigned accounts.
- Update cash spreadsheets as well as running collection reports.
- Update billing software with rate changes.
Additionally, each employer may request that you as their medical biller perform other duties aside from the above-mentioned. These duties must be fit with your training as well as work experience or in some cases, employers may provide further training for particular new duties.
HOW TO BECOME A MEDICAL BILLING SPECIALIST?
In this section, we are going to tackle the very reason why you landed on this page – the process of becoming a medical billing specialist.
If you want to work as a medical biller in whatever work setting, it is important that you take note of the following very important requirements:
- Practical Experience/Training
These also comprise the process of how to become a medical billing specialist. So, let’s dig deeper into each item —
Obtaining a related education is the primary step to become a billing specialist.
At a minimum, employers who hire medical billers require a high school diploma or GED for you to be considered for the job.
But, if you want to be highly competitive, and if you eye higher-level positions, you have to consider getting a certificate or diploma program, associate degree program, a bachelor’s degree, or a training course.
Now, let us discuss further each option:
Certificate or Diploma Program
These programs are typically offered in postsecondary education years.
However, it is important to note that both are totally different from one another.
A certificate program requires less time to complete, and have slightly more restrictive formula.
Meanwhile, a diploma program is a better-rounded curriculum and takes a little longer to finish.
Cost-wise, a certificate program is cheaper as compared to a diploma program.
Associate Degree Program
As compared to a certificate or diploma program, an associate degree is a little more expensive. It also takes more time to finish.
But the good thing about it is that it helps you become more competitive in the field. Needless to say, more employers prefer hiring someone who has at least earned an associate degree program.
In addition, if you wish to take a professional medical biller certification, some of them require an associate degree.
Bachelor’s Degree Program
Another option, and we have to say the best option is to take a bachelor’s degree program.
Normally, people who pursue a medical billing job take a bachelor’s degree in health information management or healthcare administration.
The only downside if you take this route is that it takes a while for you to finish the program — at least four years. Of course, it’s also more expensive than the other options we already provided.
Not, but definitely not the least option if you wish to become a medical biller, you may consider taking up a training course.
Training courses, however, are ideal for those who already have strong knowledge of topics like anatomy and medical terminology. It is a great option for those who already have a background related to the healthcare industry and wish to transition to medical billing jobs.
Another important requirement to get into medical billing is having practical experience or training.
There are different ways to gain experience.
First is by doing an internship. There are programs that particularly require practical experience as part of the education program.
However, if the program you’re in does not require that what you can do is to consider working as an intern in a medical office or health facility to gain the practical experience you need.
Internships may also open opportunities for you in the future especially if you want to really pursue medical billing.
Having a practical or work experience is crucial in landing a medical billing job. Furthermore, if you wish to get medical billing certification, it is important to note that many organizations require at least two years of experience as a medical biller to pass the certification exam.
If you want to be considered as highly professional in the medical billing field. Needless to say, if you are aiming for better opportunities in the industry, getting a certification is key.
When aiming for certification, it is important to note that the credentials you need will depend on the type of work you want to pursue.
For example, certified professional billers particularly handle billing operations such as submitting as well as following up insurance claims.
For your reference, here are the different medical billing certifications to choose from:
Certified Professional Biller (CPB)
A Certified Professional Biller is expected to master and have a full understanding of the various areas of the revenue cycle.
Generally speaking, CPBs act as a liaison between the physician and the insurance provider. CPBs are tasked to submit medical claims to insurance companies, process payments as well as other necessary reimbursements.
In addition, CPBs are also the ones who handle resolving of claim denials, and issuing appeals.
All Certified Professional Billers are required to comply with governmental regulations and private payer policies.
Certified Medical Reimbursement Specialist (CMRS)
The Certified Medical Reimbursement Specialist (CMRS) certification is specifically administered by the American Medical Billing Association.
This certification particularly promotes both ethical as well as professional medical billing practices. It also shows a professional’s dedication to staying proactive in the advancement of both their education and skills.
The CMRS certification recognizes professional proficiency, competency, as well as encourages constant professional development.
To be a Certified Medical Reimbursement Specialist, one must pass a national standard assessment grounded on industry knowledge.
Apart from education, experience/training, and certification, employers also look into certain hard and soft skills.
Some of the usual skills that employers particularly look for are as follows:
- Communication Skills – As a medical billing specialist, you must be able to interact effectively — whether it be over the phone, by email, or in-person — with different people including medical professionals, patients, and of course, insurance companies.
- Organizational Skills – Medical billing specialists particularly use their organizational skills to gather data from various different sources for more than one bill at a time. Being organized is key to ensure accuracy.
- Technical Skills – As a medical biller, you are tasked to generate invoices, print documents, as well as communicate with both patients and insurance companies. Thus, basic office skills, which include the ability to use computers, printers, copiers, scanners, fax machines, as well as phones are necessary. Furthermore, skills related to a spreadsheet, word processing, as well as billing software are also a must.
- Interpersonal Skills – As a medical biller, you are expected to keep clear, respectful communication with people. Apart from excellent communication skills, qualities like empathy and emotional intelligence are also important to help you understand what the other person needs and why. Furthermore, medical billers use their interpersonal skills to answer questions, solve problems, as well as in coming up with solutions.
- Analysis Skills – As a medical biller, having analysis skills is important for you to be able to understand physician diagnoses, as well as the ability to apply the corresponding codes for billing. This also helps in identifying errors, as well as in making other decisions related to insurance billing. To gain these skills, you have to specifically make time to further your knowledge in anatomy, medical terminology, as well as treatments.
Once you are done with the four major requirements for the job, it’s time to proceed to the next step, which is sending out applications.
There are a lot of companies out there that offer medical billing jobs. Some of these companies are:
GeBBS Healthcare Solutions
GeBBS Healthcare Solutions is a global entity that provides both remote and office-based jobs, which means if you want to work from home, this one’s an option.
The company, which was founded in 2005 in Los Angeles, California provides its clients with improved financial performance, compliance, as well as patient satisfaction.
Nthrive is a healthcare information management outsourcing company with an estimated 4,400 clients to date.
The company provides work from home jobs for certified medical coders, as well as quality assurance specialists, registrars, transcriptionists, and auditors.
iMedX is a company that offers a full suite of high-value revenue cycle management solutions, education, and training opportunities, as well as for analytics.
When it comes to hiring professional coders and billers, they prefer independent contractors.
The above-mentioned companies are just three of the so many companies that offer not just medical billing, but also medical coding jobs.
Himagine is the country’s largest privately held health information management outsourcing company. Currently, it supports 250 clients across 50 states.
Himagine is focused on providing services to the “healthcare industry, working with children’s and specialty hospitals, academic medical centers, large health systems, small rural and secondary market facilities, and physician and group practices across multiple specialties“.
Moreover, aspiring medical billing specialists may also find medical billing jobs through major online job boards like UpWork, ZipRecruiter, Indeed, Jobstreet, as well as LinkedIn.
You may also consider checking your local hospitals, clinics, physicians’ offices, and other healthcare facilities to check for any vacancy for a medical biller position.
HOW MUCH DOES A MEDICAL BILLING SPECIALIST MAKE?
Of course, every aspiring medical billing specialist may have this question in mind — how much does a medical biller earn?
The pay for medical billers varies depending on certain factors like education, experience, certification, and other credentials.
According to Payscale, currently, medical billing specialists make an average of $16.40 per hour. Again, depending on the factors we mentioned, it can go as low as $12.48 per hour to as high as $21.46 per hour.
Meanwhile, according to Glassdoor, the average base pay of medical billing specialists in the United States is currently at $33,716 per year. Depending on your qualifications, it could go as low as $24,000 or as high as $49,000.
FINAL THOUGHTS ABOUT BECOMING A MEDICAL BILLING SPECIALIST
Medical billers play an important role in the healthcare industry alongside medical coders. Considered as the backbones of the industry, both medical billers and coders ensure that the financial cycle of all healthcare providers is complete.
Although in some instances, a medical biller can also be a medical coder (provided the person has proper training), the two are actually different from one another. But then again, equally important in the healthcare industry.
Today, we focused on medical billing specialists. We found that in order to considered as a professional medical biller, one has to go through the process of getting a proper education, training or experience, and of course, certification.
Overall, the whole process may take some time, but it’ll be worth it in the end especially if you are eyeing to be highly competitive in the medical billing field. Needless to say, if you aim for a higher position, or for better opportunities.
So, given all the information we provided, do you see yourself still pursuing the medical billing industry?