Medical Insurance Billing Specialist Job Description

Working in environments such as hospitals and private practices, medical insurance billing specialists are responsible for processing insurance claims for healthcare institutions. Their basic work is to expedite medical billing procedures so that the practice receives what it is owed by insurance companies.

While medical insurance bulling specialists may also work as medical office assistants, they do not provide any direct medical care. The administrative part of their work includes assembling and maintaining patient records, reviewing transcriptions and interacting with doctors to ensure that all information is ready at hand. In some instances, they may also be required to provide medical procedural information to patients and families.

Position Requirements

There is little required to work as a medical insurance billing specialist as far as formal education is concerned. While you must possess deep knowledge of medical terminology, you need to only have a high school diploma or a GED (and a certificate in medical billing) to be eligible to work as a medical insurance billing specialist. You have to be detail oriented and possess deep insight into patient services and procedures. Since medical billing is a somewhat complex concept, it helps to know about the American Medical Association’s Current Procedural Terminology (CPT).

Medical Insurance Billing Specialist Job Description

• Assess all insurance claims against patient services rendered and make a to do list
• Assist patients in filling our insurance claim forms and verify form data
• Ask questions to assist in determining out any ambiguous information
• Verify completeness of information on medical insurance forms
• Post insurance billing information data into predefined database systems
• Make list of insurance companies to contact for billing purposes
• Determine how to approach each insurance company on the list, based on its reputation
• Contact insurance companies to determine status of claims
• Follow up on unpaid claims, including denial, exceptions and exclusions
• Ask why claims have been denied and provide relevant correlating information
• Resubmit denied claims with additional information to prove denial is inappropriate
• Provide information to collection agencies regarding delinquent or past due accounts
• Prepare and submit secondary claims for patients with more than one insurance coverage
• Maintain understanding of managed care authorizations and limit coverage to a certain number
• Verify patients’ benefits eligibility and coverage expanse
• Maintain knowledge of ICD9 and CPT treatments to be able to handle data entry and claim check duties appropriately
• Gather and maintain patient data including medical histories, insurance identification and diagnosis

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