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Understanding The Medical Billing Process

October 1, 2013 General 0 Comments

Understanding Medical BillingProfessionals who work in healthcare administration have to multitask, balancing patient communication with recordkeeping, appointment scheduling and other tasks. But medical billing administrative specialists tackle even more challenges that test their critical thinking and organizational skills.

Sound like a challenge that interests you?

Medical billing professionals have to know how to work with software applications and other forms of technology. They perform a diverse number of procedures and look for ways to make their routines more efficient. These professionals also have to be meticulously organized to apply the correct codes to insurance claims and follow up on submissions when needed.

To get a better idea of how medical billing administrative professionals use their skills in the workplace, take a look at this brief overview of the medical billing process below.

  1. Verify a patient’s insurance information when they arrive.
  2. Update a patient's medical record electronically based on their latest visit.
  3. Assign the correct billing codes based on the patient’s diagnosis and treatment.
  4. Verify all of the information to ensure the data entry is correct.
  5. Transmit the codes to the right insurance companies, typically by using an ANSI 837 file, so the claim can be processed.
  6. Make sure that any payments received are applied to the claims or patient statements.
  7. Review rejected claims, make corrections, and resubmit them.
  8. Follow up on resubmitted claims and repeat the process several times if the claims continue to be rejected.
  9. Explain insurance company documents to the patient.
  10. 10. Manage the ongoing medical billing process, creating reports to keep track of the workflow.

The steps a medical billing administrative specialist takes depend on their specific workplace and the billing procedures they use. Sometimes several medical billing professionals will be responsible for different stages of the process. Regardless of the specific steps, medical billing professionals perform complex duties that can be both challenging and rewarding.  

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