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.
- 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.
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.