Health Insurance: What Is a Medical Billing Advocate?

Medical Billing Advocates Ensure Accuracy in Billing

182742166_StockLib_E+_GettyImages.jpg
A medical billing advocate works on your behalf to make sure you only pay what's fair. Image © StockLib/E+ collection/Getty Images

A medical billing advocate is a specific type of patient advocate. A medical billing advocate helps patients deal with medical bills. They resolve various medical billing issues and health insurance claim problems that patients may be experiencing.

Medical billing advocates have several other titles by which they are commonly known. Medical billing advocates may also be sometimes referred to as medical bill reviewers, claims assistance professionals, or medical claims advocates.

What Do Medical Billing Advocates Do?

Medical billing advocates make sure that your medical bill is accurate by making sure that there are no extraneous claims, and by making sure that everything that should be covered, is covered. Inaccuracies occur in medical bills, and it is the job of medical billing advocates to identify, and then eliminate such inaccuracies. Medical billing advocates also make sure that your health insurance claim is handled fairly and properly, and that the amount of money that you owe overall is as small as possible.

A medical billing advocate reviews the bills you receive from a doctor or a hospital. They check for any errors and then work on your behalf to have any and all incorrect charges removed from the bill. A medical billing advocate may help you through the process of appealing a health insurance claim denial if your health insurance company refuses to pay for something that it should.

Also, if you are uninsured or if you owe a significant amount of money to an insurance company, a medical billing advocate may negotiate with your doctor or hospital in order to get your bill lowered.

Who Are Medical Billing Advocates?

The profession of the medical billing advocate is a relatively new.

The profession has developed along with health care plans. As it is relatively new, there is not a nationally recognized certification or single university degree or course of study all that medical billing advocates must have. Instead, most medical billing advocates are second-career entrepreneurs with past experience in medical billing, medical coding, medical office revenue cycle management, health insurance claims processing, or case management.

Below is a list of some of the certifications or professional licenses you might come across while looking for a medical billing advocate:

  • CCA: Certified Coding Associate
  • CCM: Certified Case Manager
  • CCS: Certified Coding Specialist
  • MSW: Master of Social Work
  • RHIA: Registered Health Information Administrator
  • RHIT: Registered Health Information Technician
  • RN: Registered Nurse

How Do I Learn More?

Learn when you should use a medical billing advocate.

Find a medical billing advocate using the AdvoConnection directory.

Learn more about medical billing advocate careers from About.com’s Patient Empowerment Expert, Trisha Torrey, in Health and Patient Advocacy Careers: Medical Bills or Claims Reviewer.

 

Continue Reading