Medical Biller's Workplace

Medical billing staff typically works in a health care environment, usually in an office away from the public's eye. Some telecommute from home. Most medical billers work forty regular office hours, Monday through Friday, where about one in seven work part time. Their work involves medical codes and data entry, which they receive from medical coders, interpreting EOB, submitting claims, collecting payments, and appealing, and resubmitting denied claims. Medical billers use a variety of computer programs to create and update databases and spreadsheets. This means they have to sit in front of a computer for hours and focus on a computer monitor, which in some cases may lead to eye and muscle strain, backaches, headaches and repetitive motion injuries.

Medical Biller's Duties

The cash flow of a medical facility depends on the medical biller's ability to accurately enter charges, efficiently process claims, processes responses from health insurance companies, which includes the Explanation of Benefits (EOB), timely billing and collection procedures, and collection methods. Submitting an electronic claim takes just seconds, while paper claim submissions cost a medical billing department about 90 days in waiting time before they see a dime. Duties may also include auditing and assigning diagnostic and procedure codes to patient records, accounting skills, bookkeeping, and typing (at least 45 words per minute) - all part of their routine. When it comes to contacting patients, health insurance companies, and other bookkeeping and billing offices, the communication is typically through email, fax, and by telephone. 

Regulations

Medical billing as a profession in the USA remains vastly unregulated. There are hardly any state or federal laws regulating training or certification, with the exception of New Jersey, which requires medical billers to be registered, and Florida where Medicaid has certain requirements of medical billers to do Medicaid Billing for providers in that state.

What does this mean? It meant that there are absolutely regulations as to what processes, or tools to use to do the job, for example, which software to use to process and submit claims. There are NO laws that mandate medical billers have to be trained to code or bill. However, to try to jump into this profession without any knowledge or training could quickly turn into a disaster for the biller and the provider. These billers would quickly find themselves in over their head, and would put the provider in real danger of going broke, or exposed to possible investigations, and audits for submitting erroneous claims.