Here’s the most frequently asked questions on medical billing careers and related topics that we receive on the site. These questions may range from subjects about everything from jobs, training, business, work from home, software, starting a home business, and more.
If you have a question about medical billing that’s not answered here, feel free to ask here.
It's turned into a fairly long page so we've categorized the questions into several sections by topic as follows - just click on the link to go to the section:
What does a medical insurance billing specialist do?
The medical billing specialist is responsible for all the processing of claims necessary for a provider to get paid. This typically starts with entering the claim information such as patient name, date of birth, address, insurance info, etc. as well as the diagnosis and treatment codes assigned by the doctor or coder. Once the information is entered the insurance claim is submitted - either directly to the insurance company or a clearinghouse. The clearinghouse performs basic error checking and submits the claim to the individual insurance company according to their required format.
After the claim is submitted and paid, the payment information must be entered into the electronic medical billing software - also called practice management software. This is shown on the Electronic Remittance Advice (ERA) or Explanation of Benefits (EOB). This includes how much was paid on each claim, the write off, patient co-insurance or deductible responsibilities, etc. If the claim was not paid, the medical billing specialist follows up with the insurance company or patient to correct and re-submit the claim.
For patients with secondary insurance coverage, the secondary claim can then be filed once the primary insurance has paid.
Once all the insurance payment is entered, any remaining balance is the patients responsibility. the medical billing specialist creates and mails out the patient statements. When patient payments are received, the specialist enters the payment into the medical billing software. When patients have questions about their bill, the billing specialist is usually the one who answers them.
They also may need to make payment arrangements (based on the direction of the doctor) for outstanding past due balances. The medical billing specialist may also determine which patient accounts are to be turned over to collections and coordinate those efforts. They may also send out collection letters reminding patients about past due amounts and warning the account may be turned over to collections.
Here’s more information on the duties of the medical billing specialist.
What skills does a medical billing specialist need?
Good with numbers and math to reconcile Explanation of Benefits with regard to the amount paid on a procedure, the write-off, patient responsibility, etc. Medical billing specialists frequently need to run and interpret reports to identify trends or problems with rejected or unpaid claims.
Technology and software skills are important in medical billing careers. Most practice management software is fairly intuitive. If you are familiar with Microsoft compatible programs, those skills are applicable to medical billing software.
Being able to read and interpret reports, explanation of benefits, and electronic remittance advice requires detail oriented skills.
Know what CPT treatment and ICD diagnosis codes are and recognize when they don’t match is very beneficial in medical billing careers. For example, if your entering a patient visit with a diagnosis code for hypertension, and a treatment code for hemorrhoids, there’s obviously a mistake - which will be promptly rejected by the insurance. company.
Trustworthy and dependable - the financial health of a doctors office and all the employees is dependent on the medical billing specialist. If claims don’t get filed and paid, neither does everyone else.
A familiarity with medical billing guidelines such as HIPAA as it relates to patient privacy.
The ability to handle and prioritize multiple tasks is a helpful skill in this profession.
Whats the difference between medical billing and medical coding?
A lot of people use medical billing and medical coding - or medical billing coding - interchangeably when discussing medical billing careers. But there is a difference between the two.
Medical billing deals with the process of reimbursement starting with entering and submitting claims to entering insurance and patient payments. A medical biller enters patient information, the treatment and diagnosis, and submits claims to the insurance company, Medicare, or Medicaid. Once the insurance is paid, the biller submits statements to the patient for the amount they are responsible for. The medical billing specialist also follows up on any unpaid or rejected insurance claims and resubmits as necessary.
A medical biller should be accurate and detail-oriented. Any omissions or mistakes means claims will not be paid or payment is delayed until the claim is corrected. Since the financial health of a medical practice and all its employees is dependant on prompt payment of claims, the medical billers roll is very important. Since they work closely with medical coders, medical billers are familiar with the codes that medical coders assign.
Medical coders assign the CPT-4 treatment and ICD-9 diagnosis codes for the patient services and procedures. A medical coder determines the appropriate codes from the patient charts or medical history which includes the doctors notations. These codes are available in the corresponding CPT or ICD classification handbook or guide. Medical coders can be certified by the AAPC (American Academy of Professional Coders) or the AHIMA (American Health Information Management Association).
Many times the duties of the medical billing specialist and medical coder are performed by the same person, especially in smaller practices. Both positions require a knowledge of medical terminology, anatomy, and medical billing (or practice management) software.
Can Medical Billers be Medical Coders Too?
Yes - being a medical billing specialist does not exclude medical coding and vice-versa. For some smaller practices the same person may have some coding responsibilities as well as performing the billing. Both the medical coder and medical biller are responsible for getting the provider reimbursed for the services provided.
What’s the typical starting pay for medical billing careers?
Don’t believe the ads you see for some generous starting salary processing medical claims from home. And all they require is you call their 800 number. No doctor is going to pay an inexperienced stranger almost $20 an hour to assume a task that is vital to the financial health of their practice. These kind of medical billing careers aren’t realistic.
A realistic starting pay for an entry level medical billing careers is anywhere from $8 to $10 an hour. For an experienced medical billing specialist who has a good reputation, the salary could reach around $20 an hour - or around $40,000 or more a year - especially if you are knowledgeable in medical coding. The average pay is around $13 to $15 an hour.
A wise doctor realizes that paying a good medical biller is money well spent. For example which do you think a physician would prefer? Paying a productive and experienced medical biller $3,300 a month ($40,000 a year) for a practice that averages $80,000 a month or .... pay a biller $2,000 a month ($24,000 a year) for a practice that averages 450,000 a month. The extra $1,300 a month expense to make $30,000 more is money well spent for a practice.
There are other medical billing careers that offer the potential to earn even more - as a medical billing business owner. How much is entirely dependent on the number of clients, how large the practices are, the competition, etc.
Here’s more information on medical billing salaries.
Can't get a job without experience - and can't get experience without a job.
It’s not unusual for an employer to prefer those with experience over those without - even for those with certification.
This isn’t unique when starting medical billing careers - I’ve seen this even with college graduates with what I thought were very in demand fields. Imagine going through four years of college and the debt that goes with it and not being able to get a job. My husband went through the same thing after getting an engineering degree in the mid 1980’s before getting a job after an extended search.
Probably the biggest advantage in getting a job is networking - with everyone and anyone. You never know who may know someone or have a connection to someone who is hiring. Your neighbors, friends, acquaintances at church, your spouses friends, Facebook friends......I was lucky to have a friend in the business that hired me to get some valuable experience. I was actually willing to work for free for a while but they were kind enough to pay me.
For a first job, I would recommending concentrating on smaller practices or billing services. In our city I see occasional advertisements for temp agencies looking for medical billing or coding specialists. They may not always pay the best but it’s one way to get some experience. And it doesn't have to be for a long time.
Another approach is to emphasize experience on your resume or application that applies to medical billing or coding. Take credit for your strengths and any similar experience that applicable to medical billing careers. Even if it’s in something unrelated likes sales or landscaping or those jobs as a teenager - there are skills accomplishments and experience that show you are a good employee. There are billing services that don't necessarily look for employees with a lot of billing experience, but someone that can be trained in their systems and processes. Computer and technology skills, work processing, math and accounting - these are applicable skills. Emphasize any software experience or skills - these are important these days. Take credit for your past experiences that transfer to medical billing.
Experiences you can include in your resume or mention in an interview that demonstrates you are a self-starter, are detail oriented, trustworthy, thorough, etc.
If you have spent the time and effort to get certified, that shows you are committed to the profession and care about it. It also insures you meet minimum standards of excellence in the field.
What is the work environment like for medical billing careers?
Medical billing specialists work in a pleasant and comfortable office environment. This is usually in a health care facility such as a hospital, physicians office, clinic, or billing service. This is one of the few health-related occupations in which there is little direct hands-on interaction with the patient other than answering occasional questions patients have regarding their account.
Medical billers typically work a 40-hour schedule and may sometimes work overtime. About 15 percent of workers in medical billing careers work part-time according to department of labor statistics.
Depending on the employer, dress is typically casual and comfortable.
Where do medical billing specialists work?
Most jobs in medical billing careers work for physicians offices, clinics, billing services, hospitals, or managed care facilities such as nursing homes.
Whats the job outlook for medical billing careers?
According to the U. S. Department of Labor - Bureau of Labor Statistics, the outlook is very optimistic. The Bureau statistics don’t categorize medical billing buy it self, but consider it part of Medical Records and Health Information Technicians. Projected growth is much faster than average with very good job prospects, especially for those with a good understanding of technology and software skills.
This category that includes medical billing careers is expected to grow over 20% for the next ten years. This is much than over occupations. It is anticipated that the increasing need for electronic patient medical records will require more workers to manage this technology.
If you have a question about medical billing careers that’s not answered here, feel free to ask here.
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