Medical Biller

Experience Level

Primary Roles & Responsibilities

• ABA billing experience.

• TMS (Transcranial Magnetic Stimulation)

1. Claim Preparation and Submission

• Collect and verify patient and insurance details.
• Translate physician services into billable codes (often in collaboration with a medical coder).
• Accurately generate insurance claims using

  CPT, ICD-10, and HCPCS

  codes.
• Submit claims electronically or via paper to insurance payers (Medicare, Medicaid, private insurers).

2. Insurance Verification and Preauthorization (Calling & Online Checking)

• Confirm patient insurance eligibility and coverage before services are rendered.
• Obtain prior authorizations when required by insurance providers.

3. Claim Follow-Up

• Monitor submitted claims for acceptance, rejection, or denial.
• Identify and correct any denied or rejected claims.
• Resubmit corrected claims promptly.

4. Payment Posting and Reconciliation

• Post insurance and patient payments in the billing system.
• Review

  EOBs (Explanation of Benefits)

  and

  ERAs (Electronic Remittance Advice)

  .
• Reconcile posted payments with deposits and patient accounts.

5. Patient Billing and Communication

• Generate and send patient statements electronically for outstanding balances.
• Communicate with patients (if approved by doctors) regarding billing issues, insurance questions, and payment options.
• Assist in setting up payment plans if necessary.

6. Compliance and Confidentiality

• Ensure full compliance with

  HIPAA

  and all relevant billing laws.
• Maintain strict confidentiality of patient and financial data.
• Stay updated with changing payer guidelines, coding rules, and healthcare regulations.

7. Reporting and Documentation

• Generate billing and financial reports for physicians or practice managers.
• Maintain accurate records for internal reviews and external audits.

Skills & Knowledge Required

• Strong understanding of

  medical terminology, anatomy

  , and medical coding systems (

  ICD-10, CPT, HCPCS

  ).
• Proficiency with billing software (e.g.,

  Kareo, AdvancedMD, Athenahealth

  ) –

  varies by client requirements

  .
• Familiarity with specific specialties (e.g.,

  Mental Health, Pediatrics, Internal Medicine, Cardiology, Orthopedics

  , etc.) –

  client-dependent

  .
• Excellent attention to detail and organizational skills.
• Effective communication and customer service abilities.
• Solid knowledge of payer-specific rules and federal programs like

  Medicare / Medicaid

  / Commercial insurance.