Medical Biller

Job Description Elements for Medical Billing Clerk or Specialist

Caucasian nurse working at computer in hospital
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A medical biller is responsible for submitting medical claims to insurance companies and payers such as Medicare and Medicaid. It is a position that is critical for the financial cycle for all health care providers, from single-provider practices through large medical centers. It requires attention to detail and experience with the electronic and paper systems used in medical billing.

If you are interested in medical billing as a career, you can explore the elements often found in a job description for the position below.

If you are updating or writing a job description for the position, you can use the elements below and modify them as is appropriate for your facility.

Job Description - Medical Biller

Responsible for the timely submission of technical or professional medical claims to insurance companies The position may be located in physician offices, hospitals, nursing homes, or other healthcare facilities.

Job Duties for Medical Biller

  • Obtain referrals and pre-authorizations as required for procedures.
  • Check eligibility and benefit verification.
  • Review patient bills for accuracy and completeness and obtain any missing information
  • Prepare, review, and transmit claims using billing software, including electronic and paper claim processing.
  • Knowledge of insurance guidelines, including HMO/PPO, Medicare, and state Medicaid
  • Follow up on unpaid claims within standard billing cycle timeframe
  • Check each insurance payment for accuracy and compliance with contract discount
  • Call insurance companies regarding any discrepancy in payments if necessary
  • Identify and bill secondary or tertiary insurances
  • All accounts are to be reviewed for insurance or patient follow-up
  • Research and appeal denied claims.
  • Answer all patient or insurance telephone inquiries pertaining to assigned accounts.
  • Set up patient payment plans and work collection accounts
  • Update billing software with rate changes.
  • Updates cash spreadsheet, runs collection reports.

Education and Experience Required

  • High School diploma.
  • Knowledge of business and accounting processes usually obtained from an Associates in Business Administration, Accounting or Health Care Administration preferred.
  • Minimum of one to three years in a medical office setting.

Knowledge, Skills, and Abilities

  • Knowledge of HMO/PPO, Medicare, Medicaid, and other payer requirements and systems.
  • Use of computer systems, software, 10 key calculator
  • Effective communication abilities for phone contacts with insurance payers to resolve issues.
  • Customer service skills for interacting with patients regarding medical claims and payments, including communicating with patients and family members of diverse ages and backgrounds.
  • Able to work in a team environment.
  • Problem-solving skills to research and resolve discrepancies, denials, appeals, collections.
  • Knowledge of accounting and bookkeeping procedures.
  • Knowledge of medical terminology likely to be encountered in medical claims.

Expected Salary for Medical Biller

The median salary for medical billing clerk was $34,458 in November 2016.

The median salary for billing specialist was $39,973 in November 2016. Salary amounts vary based on years of experience, education, and job location.

Current Job Openings for Medical Biller

Find current job openings for a Medical Biller and similar positions.

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