Insurance Billing Specialist Job Description

Job Description and Duties of the Medical Billing Specialist

Below are the job duties and job description for an insurance billing specialist. This includes the most commonly performed duties and responsibilities of the job.



Insurance Billing Specialist Summary

  • Collect and entering claim information.
  • Post insurance and patients and manage accounts.
  • Submit claims and following up with insurance carriers on unpaid or rejected claims.
  • Answer patient inquires on account status and charges.
  • Typically reports to billing supervisor or provider office manager.

Knowledge, Skills, & Abilities

  • Enters information necessary for insurance claims such as patient, insurance ID, diagnosis and treatment codes and modifiers, and provider information. Insures claim information is complete and accurate.
  • Submits insurance claims to clearinghouse or individual insurance companies electronically or via paper CMS-1500 form.
  • Answer patient questions on patient responsible portions, copays, deductibles, write-off’s, etc. Resolves patient complaints or explains why certain services are not covered.
  • Follows up with insurance company on unpaid or rejected claims. Resolves issue and re-submits claims.
  • Prepares appeal letters to insurance carrier when not in agreement with claim denial. Collect necessary information to accompany appeal.
  • Prepares patient statements for charges not covered by insurance. Insures statements are mailed on a regular basis.
  • May work with patients to establish payment plan for past due accounts in accordance with provider policies.
  • Provides necessary information to collection agencies for delinquent or past due accounts.
  • Posts insurance and patient payments using medical claim billing software.
  • May perform “soft” collections for patient past due accounts. This may include contacting and notifying patients via phone or mail.
  • For patients with coverage by more than one insurer, prepares and submits secondary claims upon processing by primary insurer.
  • Follows HIPAA guidelines in handling patient information.
  • May periodically create insurance or patient aging reports using the medical practice billing software.These reports are used to identify unpaid insurance claims or patient accounts.
  • Understands managed care authorizations and limits to coverage such as the number of visits. This is encountered often when billing for specialties.
  • May have to verify patient benefits eligibility and coverage.
  • Ability to look up ICD 9 diagnosis and CPT treatment codes from online service or using traditional coding references.


Behavioral Attributes

  • Knowledgeable on insurance and reimbursement process.
  • Good math and data entry (typing) skills.
  • Exercises good judgement and discretion.
  • Familiarity with HIPAA privacy requirements for patient information. Maintains and protects confidential information.
  • Proficient in use of computers and common office equipment.
  • Good verbal and written communication skills.
  • Basic understanding of medical ICD 9 codes and CPT medical billing codes.
  • Good telephone and patient relation skills.
  • Detail oriented and ability to prioritize work.
  • More experienced insurance billing specialists work with minimal direction and oversight.


Education

High School Diploma or GED. Typically includes some post secondary education in a Medical Billing certificate program ranging from 1 to 2 years.


This is just an outline summary of the most commonly performed tasks and responsibilities of the insurance billing specialist. Depending on the practice or employer, these may differ depending on business needs.

The most important goal of the medical billing specialist is to get the provider paid promptly - and to insure billing practices are ethical and compliant with government regulations and guidelines when doing so.




Return from Insurance Billing Specialist to All-Things-Medical-Billing

Return from Medical Insurance Billing Specialist to Medical Billing Specialist



Recent Articles

  1. Is it possible to work in Medical Billing or Coding at night instead of during the day?

    Oct 23, 17 09:16 PM

    How common is it that a company would allow you to work from home as well as working at night so you can be with your children during the day? I'm an

    Read More

  2. Should I get my medical billing certificate from AAPC or somewhere else before I start my own business?

    Oct 23, 17 09:15 PM

    Hi! I am contemplating starting my own medical billing business and I was wondering if I should get my medical billing certificate from AAPC or some other

    Read More

  3. What is the CPT code for 'Male Hormone Panel'

    Oct 23, 17 08:57 PM

    What is the CPT code for 'Male Hormone Panel' ...testosterone/estrogen/PSA/IGF- 1 /DHEA -Sulfate/ Progesterone Response: We'll post in hopes our Visitors

    Read More

Disclaimer and Privacy

All-Things-Medical-Billing.com provides this website as a service. Please read our full Disclaimer and Privacy Policy here.


Copyright 2017 All-Things-Medical-Billing.com