Medical billing specialists are essential for any small medical practice to ensure accurate, efficient, and proper payment for services. For healthcare providers, it can be especially beneficial to have experienced, knowledgeable professionals to take charge of billing to ensure that nothing falls through the cracks and that each claim is handled accurately and on time.

In this article, we’ll explore the benefits of a medical biller, explain the tasks they handle, and discuss the ideal qualifications you should be looking for when adding a medical billing specialist to your small practice.

What Does A Medical Billing Specialist Do & How Does It Differ From Coding?

Medical billing specialists and medical coders play important roles in the medical sector, but the two jobs have some subtle differences

Here’s a closer look at the day-to-day duties of a medical billing specialist and how it differs from a medical coder:

Medical Billing

Medical billing specialists work by submitting claims to insurance companies and other payers on behalf of the medical facility or healthcare provider. Ultimately, their job is to ensure the provider gets paid for the services that were performed.

They enter patient information into the facility’s billing software, review and audit claims, and determine the best way to submit them to maximize reimbursement. Additionally, medical billers must also be familiar with coding systems, as they use them to identify and assign the appropriate codes for services and procedures.

Medical Coding

Medical coders, on the other hand, are responsible for accurately and precisely entering patient information, diagnoses, and procedures into the medical facility’s coding software.

They are the ones who assign the codes for services provided and ensure information is accurately entered into the facility’s medical records. A big part of their role is their firm understanding of medical terminology and anatomy, as well as the International Classification of Diseases (ICD-10) coding system among others.

The Benefits of Hiring a Medical Billing Specialist

If you own a small medical practice, you know that managing the billing portion of your business can be a real headache. From making sure you keep up with insurance payment schedules to setting up accounts with various insurance providers and efficiently entering the data from patient visits, it can be exhausting.

Hiring a medical billing specialist can make these tasks much easier for you and your staff. 

So, when thinking what does a medical billing specialist do for my practice, consider just a few of these benefits:

1.   Increased Efficiency

A medical billing specialist can take care of the administrative side of your business, so you and your staff can focus on more important tasks like patient care.

Additionally, they will ensure that all billing information is entered correctly, which can greatly reduce the time you and your staff have to spend on paperwork.

2.   Improved Cash Flow

As a small business owner, you understand the importance of keeping expenses low and cash flowing into your practice. With a medical billing process, you can rest assured that your billing processes are running smoothly, resulting in less time spent on billing and more timely payments from insurance companies and patients.

3.   Fewer Denied Claims

Working with a medical billing specialist can also help you avoid rejected claims due to incorrect coding or paperwork. A medical billing specialist can monitor your billing to ensure that all claims are accurately coded and paperwork is up to date, resulting in fewer denied claims.

What Should I Look For In A Medical Billing Specialist?

When outsourcing to a medical billing and coding specialist it is crucial they’re a competent partner who can get the job done efficiently so you get the most out of your payments.

It’s important to be aware of the skills medical billing specialists need to possess to ensure they’re up to the task. Here’s a list of what you should look for when you’re ready to hire:

      1.  Knowledge of Medical Terminology

The language of the medical field is dense and complicated. A medical billing specialist should be knowledgeable in the use of this terminology to ensure accurate communication when dealing with insurance companies, providers, and patients.

      2.  Skilled in Record-Keeping

Record-keeping is an integral part of medical billing. Medical billing specialists must be able to keep track of patients’ records, patient visits, payments, and other data related to the billing process.

       3.  Attention to Detail

Medical billing specialists need to be very detail-oriented in order to scrutinize the various documents that come their way. From invoices to medical claims, everything needs to be checked thoroughly to avoid incorrect transfer of payments.

      4.  Proficiency in Computer Programs

Medical billing is conducted with the aid of software programs. A medical billing specialist should have the ability to use such programs with ease and know their way around troubleshooting any issues that may arise.

     5.  Good Communication Skills

Medical billing specialists will be dealing with different people on a daily basis – insurance companies, providers, and patients. They need to have strong communication skills to navigate these conversations.

     6.  Ability to Work Under Pressure

Medical billing can be a stressful job, given the strict deadlines for claims and payments. The specialists need to be able to juggle their tasks and prioritize tasks effectively.

For a medical billing service that can provide all of the above, contact PMN at (949) 215-5055 or by visiting their office in Laguna Hills, Orange County, California. 

FAQs

What Does A Medical Billing Specialist Do To Reduce The Time Spent Dealing With Billing Issues?

By enlisting the help of a medical billing specialist, you should spend less time dealing with billing issues and more time focusing on the health of your patients. They take care of all the billing paperwork meaning you can focus on providing quality care and attending to all other aspects of your practice.

What Does A Medical Billing Specialist Do To Become Qualified?

You should look for a medical billing specialist who has a working knowledge and experience of coding, billing, collection processes, and regulatory compliance. Ideally, they should have either a Certified Professional Coder (CPC) certification or a Certified Coding Associate (CCA) designation. Additionally, prior experience working with medical practices is a major plus.