As a medical biller, you’re a provider’s key to getting paid. Most providers get into medicine because they want to contribute to the greater good, not to deal with the headaches that come with insurance payers. They’re happy to delegate the sometimes-tedious processes of billing and collecting to specialists. Some Medical Reimbursement Specialists, as billers are sometimes described, completely manage a medical practice’s revenue cycle, from coding and submitting claims to billing patients to tracking accounts payable and receivable.
Others limit their responsibility to submitting insurance claims.
This is usually done by staff that is internal to the physician’s office. Other practices decide to outsource all billing functions to a dedicated third party that specializes in maximizing collections, streamlining operations, and reducing costs; a medical billing company.
So what does it take to start a medical billing company? Understanding the complex insurance industry by previously working for a payer or a provider will give you a great foundation. In addition, there are at least three key soft skills one must possess to succeed with a medical billing business.
Strong People SkillsThe ability to get along and work well with others is important in a lot of jobs, but especially in the medical billing world. Whether dealing with medical practice staff to clarify documentation, insurance claims personnel regarding payment status, or patients trying to decipher a provider’s statement, communication is key. When a doctor fails to document an included procedure or provides too few details to justify the service level of service indicated, the biller must return to the practice and get it corrected. This requires confidence, initiative, the ability to speak respectfully and concisely — and sensitivity to timing interactions so as not to jeopardize practice workflow. Most healthcare providers have contracts with multiple payers including private insurance companies and government payers like Medicare and Medicaid. Commercial insurers may be organized as preferred provider organizations (PPO), health maintenance organizations (HMO) or point-of-service plans (POS). Each category has different rules about what’s covered when and how providers get reimbursed. The medical biller needs to learn payers’ differing definitions of a clean claim submission and be able to communicate effectively with payer representatives at many levels. Perhaps even more importantly, this communication must start with a strong sense of integrity. Working with people’s private health information requires maintaining confidentiality. Owning up to mistakes made in the rush of business facilitates the productivity and teamwork necessary to keep a provider’s revenue cycle running smoothly.
The Ability to Learn QuicklyTechnology has enabled workers to accomplish more in less time with fewer people involved. Time is money. Overlay that general sense of urgency with responsibility for human life and health— add a massive overhaul in how healthcare is delivered —and you have an industry struggling toward profitability. This increases the pressure on everyone involved in medical practice, especially billers tasked with keeping revenue streams flowing as efficiently as possible. The medical biller’s job demands a range of skills, beginning with basic administrative tasks such as typing, data entry and database management. Strong math skills, thorough understanding of the ICD-10 handbook’s coding descriptions, and attention to detail are necessary to avoid overcharging patients or delaying provider payments. Currently there are no set educational standards for the medical billing profession. Industry organizations like the American Billing Management Association (AMBA) offer certification processes. However, most medical billers today prefer hand-on learning while earning in an entry-level billing job.