What Role do Medical Billing Specialist Play in Financial State of Healthcare Facility?

medical billing and coding specialist

The primary role of a medical billing specialist is maintaining the financial condition of the medical care providers. The trained professionals handle the billing process, during which they prepare, submit and keeping track of the insurance claims with patients and providers. The professionals aim to receive payments, at the earliest, for the healthcare services provided. In short, these specialists are the link between healthcare providers and insurance companies, ensuring that the healthcare providers get paid. Market experts believe that an experienced specialist would help boost the revenue health of the medical care provider.

medical coding specialist, also known as medical coders or billers, aid in managing health care facilities’ financial transactions. The key responsibilities of this professional include:

  • Invoices preparation
  • Claim submission
  • Entering different codes for treatments
  • Correction of rejected claims and resending for approval
  • Payment tracking

Relationship between Biller and Coder

Billers and coders, both these professionals work at places where patients go for tests, diagnosis or treatment. In recent times, healthcare facilities are looking for digital medical billing solutions, which would help boost their revenue. A dedicated app or software would help make the task simpler and error-free; thus, faster processing and more patients.

Medical Coder

A medical coder is responsible for taking proper diagnostic and procedural notes and converts them into correct codes. They are significant for increasing the chances of successful claims with medical coding services. The medical industry uses unique combinations of alphabets and numbers for codes. These codes play a primary role during insurance claims, as they help recognize the services, diagnosis and treatment. In general practice, the medical coding specialist would use appropriate codes, from appointment to completion of treatment. Type of visit and patient’s symptoms and others aid the coder to enter correct codes; as treatment progresses and different tests are conducted for proper diagnosis, the staff would enter codes into the patient’s profile.

Medical Biller

As the treatment reach the final stage, the medical billing specialist would generate invoices and send them to the patient’s insurance providers. The insurance companies would approve or deny claims, depending on the codes entered in the invoice. If the insurance companies do not cover any treatment or procedure in the patient’s plan, they would inform the healthcare provider, who would contact the patient for balance payment.

The billing process begins with the appointment, during which the medical coding specialist submits codes to the insurance company for pre-approval. It would help find which procedures come under the patient’s insurance claim and those for which the patient needs to make payments.

A responsible medical billing specialist would have a clear understanding of the medical codes. It is crucial because billers need to review the denial reasons. They would be responsible for making the corrections and resubmitting the claims; further, they would verify with the coders during resubmission.

Need of Combining Both Roles

The biller’s responsibility does not end with submission and corrections. The specialist determines the pay requirements, track payments and follow up on outstanding payments both from insurance companies and patients. The other responsibility of the billing specialist is to contact insurance companies regarding non-payment of billing. If the insurance provider is not paying the full amount, the biller needs to send the bill balance to the patient. If the patient does not make payments within the specified timeframe, the billing specialist seeks collection agents’ help.

Billing and coding are inter-related; hence, many health care facilities prefer to hire a professional and train them to handle both billing and coding. Bigger healthcare facilities prefer hiring a team for the purposes.

It may be hard for the professionals to handle this monotonous work. Seeking good software that acts as a medical billing and coding specialist would speed up work and reduce errors, thereby improving the health care’s financial health.

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