If you've been considering a career in the healthcare industry, want to work with healthcare professionals, and enjoy paperwork involving spreadsheets and calculators, a job as a medical billing specialist might be perfect for you. Medical billing specialists work in all types of healthcare practices from family offices to walk-in clinics to hospitals.
What Is Medical Billing?
Medical billing is the process in which a person submits and follows up on medical claims with health insurance companies. The goal is to receive payment for a healthcare provider's services. The medical billing specialist acts as the bridge between the medical professional and the insurance company, making sure the practice gets paid. If a medical billing specialist is knowledgeable, they can improve the practice's overall revenue performance.
How Do You Become a Medical Biller?
The first step to becoming a medical billing specialist is to get a high school diploma or a GED. For medical billing specialists still in high school, it helps to focus on algebra and science, since the majority of the work will be related to finances and healthcare.
Most employers will want a medical billing specialist to have knowledge of accounting software and general business processes. They are looking for candidates with associate's degrees in Health Care Administration, Accounting, or Business Administration. There are certification exams that they can take. Obtaining these certifications helps show employers that a medical billing specialist understands all the typical aspects of the medical billing process.
A vocational school can train a medical billing specialist in every aspect of the medical billing job. Some programs may combine medical billing and coding programs. If a practice is small enough, they may hire one person to handle both coding and billing responsibilities, rather than hiring two people to split the workload.
It's important to learn about different insurers and how they function. In the United States, there are many different insurance companies that have different policies. Some companies are private, while others are funded by the government. The most common providers a medical billing specialist will need to be familiar with are:
- Commercial claims companies
- Blue Cross
- Blue Shield
- Workers' compensation claims
Before a medical billing specialist begins working in a professional setting, they should be proficient in these areas:
- Understanding of insurance guidelines including the majority of private insurance companies, Medicaid, Medicare, HMO companies, and PPO companies
- Familiarity with ICD-10 and CPT coding
- Ability to use 10 key calculators, financial software, and computers
- Ability to communicate and resolve issues with insurance representatives
- Customer service skills when interacting with patients and their family members
- Ability to do teamwork and delegate tasks
- Ability to manage conflict and come up with compromising solutions to problems
- Ability to research policies and identify discrepancies
- Understanding of bookkeeping and accounting procedures
- Understanding of medical terminology that commonly appears on medical claims
- Comprehension and upholding of patient confidentiality laws through HIPAA compliance
- Capability to multitask
Quality #1: Communication Skills
One of the most important qualities for a medical billing specialist is good communication skills. Most aspects of the job involve communicating with other people.
The medical billing specialist needs to review the patient’s bills to make sure they're complete. If they aren't complete, they will need to talk to the health professional to find the missing pieces. It's important to communicate so that the other party understands what pieces are missing and can efficiently give a medical billing specialist the necessary information.
A medical billing specialist may also be responsible for obtaining referrals for patients from the healthcare professionals in their setting. Alternatively, if patients need a referral to a healthcare professional in their practice, a medical billing specialist may need to reach out and contact general practitioners. Pre-authorizations might also be their responsibility.
Another one of the most common duties a medical billing specialist will have is following up on bills that aren't paid during the standard cycle. There are two typical pieces to this: talking to insurance companies that haven't yet paid their claims and talking to patients who still need to pay their copays. It's important that a medical billing specialist is able to explain the situation and are firm about receiving payment.
If an insurance company denies a claim, a medical billing specialist will have to research the claim and appeal the denial. This means being able to confront the insurance company and present well-researched evidence about their policies in a clearly-communicated way.
A medical billing specialist needs to do a lot of talking on the phone. Insurance representatives and patients alike will call with questions about their accounts and bills. A medical billing specialist needs to answer questions, explain policies, and help people understand what they have to do.
Quality #2: Active Listening
Active listening is another one of the most important qualities for a medical billing specialist. It goes hand-in-hand with good communication. Not only do medical billing specialists need to make themselves understood, but they need to understand others.
One area in which active listening is important is when a medical billing specialist talks to the healthcare professionals they work with. They will need to listen to them when they explain the procedures done or any special considerations they should take into account.
Active listening is also important when a medical billing specialist is talking to insurance representatives. In most cases, after they send out a bill, the insurance company will pay, and no further action is required. However, in those cases when the insurance company denies the claim, the medical billing specialist needs to talk to the company about the reason behind the denial. It's important to obtain as much information as possible, especially if they plan to do research to have the claim approved.
A medical billing specialist will also need to employ active listening when they talk to patients, especially patients whose payments are overdue. Some patients may have trouble paying their copays, especially if the amount is high.
Quality #3: Ability to Problem Solve
The ability to problem solve is another one of the important qualities necessary for a medical billing specialist. Their job involves more than just issuing bills. They also have to communicate with the insurance companies and patients when payments are late, or when things go wrong in the payment process.
It's important to approach every interaction with the goal of finding a solution. When they are talking to insurance companies about denied claims, a medical billing specialist should try to find a way to appeal the claim or otherwise get the necessary payment. With patients, you may be responsible for setting up work collection accounts and patient payment plans.
The ability to problem solve will be most important when interacting with patients. Unlike insurance companies, many patients simply don't have the funds to pay their bills right away. When they make patient payment plans, there should be collaborative efforts that reduce the financial burden for the patient while still ensuring their practice eventually gets paid.
Quality #4: Time Management
Time management skills are another one of the most important qualities for a medical billing specialist. Most medical billing specialists have relatively independent jobs. While their office will typically be in the clinic, hospital, or doctor's office they serve, they have a good deal of freedom over what tasks are completed and when.
Their day won't usually be scheduled from hour to hour. Instead, a medical billing specialist has a certain amount of work that needs doing, and they get to choose the manner in which their tasks are executed. A medical billing specialist may have supervisors who double check their productivity levels and make sure they aren't falling behind.
Because of this, it's essential that a medical billing specialist learns to manage their time. Every moment they spend at their job should be put to good use. Medical billing specialists have a huge amount of responsibilities, and the work can pile up, especially if they work at a moderately sized practice.
A medical billing specialist will need to issue bills and follow up on the payments. They will need to communicate with medical professionals, coders, insurance companies, and patients as previously mentioned. On top of these tasks, they will be responsible for certain aspects of software management. A medical billing specialist will have to set up work collection accounts when patients are paying their bill on a long-term basis and be familiar with their practice's billing system and records.
When there are rate changes, they will need to update their billing software to make sure it continues making accurate calculations. A medical billing specialist will also need to update cash spreadsheets and run collection reports as needed. They may be responsible for preparing financial information for the practice's accountants. They might also need to create reports that reflect the practice's current financial trends and expenses.
Quality #5: A Solid Organizational System
A solid organizational system is key to both doing a job well and preserving one’s sanity. Not only do medical billing specialists want to easily find information for their own purposes, but they want to retrieve it easily for others.
If patients or insurance companies call to ask about different claims, they will want to be able to pull them up quickly and easily. A medical billing specialist will also want to keep track of every payment made and outstanding balances. Depending on where they work, they might also need to record the practice's business expenses.
Basically, a medical billing specialist needs to make sure that all the financial information they handle is easily accessible. Whether they are looking it up to amass a quarterly report or opening a file because a patient just called, knowing where everything is will save them endless time and energy.
Quality #6: Attention to Detail
Attention to detail is an important part of being a medical billing specialist. The job involves more than issuing bills and recording payments. They also need to take a look at every payment to make sure the information matches up with their records. If there are discrepancies, a medical billing specialist will have to follow up with the insurance companies.
Payment discrepancies are usually the result of human error, sometimes from inputting incorrect information into a calculator or writing down the wrong number by hand. A medical billing specialist needs to be detail-oriented enough to notice discrepancies in payment. If they don't notice payment discrepancies, their practice could lose revenue. At worst, there could be problems with their financial bookkeeping and tax information.
Quality #7. Ability to Multi-Task
It's important to be good at multitasking. There are a number of different things a medical billing specialist will need to do each day. Rather than being a monotonous job, they will have to execute different tasks. There's no telling exactly what each day will look like.
A medical billing specialist needs to complete multiple tasks at once. In addition, they will need to have their current tasks interrupted by things like phone calls or people entering the office. When they talk on the phone, they will need to answer questions while pulling up files and navigating their billing software.
Quality #8. Intuitive Learning
A medical billing specialist will need to learn quickly and pick up whatever new skills are necessary. After they become certified as a medical billing specialist, they will have a number of skills and a fuller understanding of the profession's requirements. However, every setting they work in will have slightly different operations.
A medical billing specialist will have to learn to use the billing software. It helps to be familiar with different programs and to look for shortcuts that help them optimize the software for maximum efficiency.
A medical billing specialist will also need to become familiar with different aspects of the practice. For example, they will need to find out what insurance companies are most commonly billed and what their policies entail. They may need to familiarize themselves with government-subsidized programs like Medicare and Medicaid.
A medical billing specialist will have to learn about the patients. On a birds-eye level, they have to know what types of patients their practice serves, what the most commonly performed procedures are, and what the most common billing issues are. On a more detail-oriented note, it will help to become familiar with the practice's most common patients and their unique needs.
A medical billing specialist’s initial training will teach them all the skills they need to do their job properly. But the learning doesn't stop after they are certified. Every new workplace they enter will involve a learning process where they find out about the unique billing challenges and circumstances there.
Quality #9. Conflict Management Skills
A medical billing specialist will need to use conflict management skills at times. Being a medical billing specialist can be stressful at times, especially when they need to follow up on payments with patients. A medical billing specialist will have to balance compromise with a solution that's best for the practice. This often involves making long-term payment plans or connecting with insurance companies to try to get more of a claim paid.
A medical billing specialist might have to deal with heightened emotions during some of these conversations. It's important to understand how to keep their own tone level and reasonable.
Quality #10. Ability to Work in a Team
Teamwork is an essential skill as a medical billing specialist. The job is often a solitary and independent one, especially in small practices. A medical billing specialist will choose what their day-to-day workload looks like and what tasks they complete at what times.
With that said, larger practices may have teams of medical billing specialists. They might have to coordinate with the other medical billing specialists to make sure everyone understands their responsibilities and deadlines.
A medical billing specialist should also have a teamwork approach to working with medical professionals. A medical billing specialist will often need to follow up with them about patient care and specific procedures. In addition, they might have to answer their questions or the questions of patients. If a patient wants to know whether their insurance policy covers a certain test or procedure, that question will come to their department.
Quality #11. Reliability
A medical billing specialist for any practice needs to be reliable. They need to be committed to doing their job in an efficient, productive manner. There are multiple people who put their faith in them, even if they aren't interacting with them every day.
The health professionals trust a medical billing specialist to take care of billing so that they can receive compensation for their services. Patients rely on a medical billing specialist to understand their insurance policies and navigate the complex waters of insurance claims for them.
In addition, reliability is an important trait for a medical billing specialist. If they have reliable systems for keeping up with the workload, they don't have to worry about falling behind. If they have reliable sources to answer their questions, they won't feel like they are lost.
Essentially, a medical billing specialist should try to be the kind of professional that they would trust to keep things running, since so much of the practice's efficiency depends on them.
Quality #12. Positive Attitude
A positive attitude is a must in every profession, but it's especially important as a medical billing specialist. Positivity will help to interact more easily with coworkers. In addition, insurance company representatives and patients alike tend to be more responsive to positivity than irritability. A positive attitude could help a medical billing specialist get their job done more easily!
Not only that, but a positive attitude is good for a medical billing specialist’s physical and mental health. Happiness is a fleeting emotion that can't be controlled, just like sadness or anger. But a positive outlook is a choice one can make each day. Choosing to see the good in things will make a medical billing specialist feel happier about every aspect of their life, from the workplace to their home life.
Quality #13. Humility
It's important for a medical billing specialist to have a sense of humility. Being humble doesn't mean downplaying one’s accomplishments or failing to understand one’s importance. It also doesn't mean failing to celebrate when something is done right.
In fact, humility goes hand-in-hand with understanding a medical billing specialist’s importance. They are responsible for the financial efficiency and recording of their practice. They act as the go-between for health professionals, patients, and insurance companies. As such, it's important that they understand their own limitations. Just like insurance companies can make mistakes due to human error, a medical billing specialist can also be subject to human error. No matter how many times they double-check their work, a medical billing specialist is probably going to make a few mistakes over the course of their career.
A good medical billing specialist should understand that perfection is impossible. When they make mistakes, they should be willing to own up to them and correct them instead of ignoring them. Making mistakes is a normal part of working, and it doesn't mean they are bad at their job. It's how they respond to and correct those mistakes that measures whether they are a good medical billing specialist or not.
Quality #14. Empathy
A sense of empathy is important, especially when a medical billing specialist is talking to patients who are struggling to pay. It's easy to get caught up in the numbers-related part of the job. But it's also important to remember that the patients are human beings who, for the most part, are doing their best.
Medical bills of any kind can put a strain on a person, even in seemingly small amounts. When people have chronic conditions, needing to set aside money for bills each month can be overwhelming and upsetting, especially if their income is limited. On the other hand, unexpected medical bills can overwhelm people who hadn't prepared for this kind of financial strain.
It's important to remember that patients are people who are looking after their health. A medical billing specialist should look for solutions that prioritize their concerns and circumstances.
Quality #15. Compassion
Compassion is essential for any healthcare-related field. It doesn't matter if someone is a doctor, biller, coder, nurse, or other healthcare professional. If one is going to be working in any sort of proximity to patients, they should have compassion for everyone.
The healthcare field exists to help people get better. In many ways, a medical billing specialist will need to be an advocate for patients when they talk to insurance companies about paying their claims. A medical billing specialist compassion should drive them in this regard.
Quality #16. Self-Motivation
As previously mentioned, most medical billing specialists will end up working with a fair degree of independence. Their office may be removed from the rest of the practice. They might work near the medical assistants and receptionists, or they may be on their own for the whole day.
A medical billing specialist will likely have a supervisor who will touch base to make sure they are keeping up with work. But other than that, the structure of their day is up to them. A medical billing specialist must make their own goals, rewards, and plans.
For this reason, they should be a self-motivated person. A medical billing specialist should enjoy working and interacting with other people, but they should also prefer a job where they are their own responsibility.
Quality #17. A Proactive Approach
A good medical billing specialist will take a proactive approach to their job. This means keeping track of payments and recording them as soon as they come in, following up on late payments in a timely manner, and putting together a system to continue following up on late payments.
If a medical billing specialist finds discrepancies in payments or has questions about the content of bills, they should contact the people who can answer their questions. Overall, their goal should be to use a combination of problem-solving and proactive interaction to get their work done efficiently. Instead of waiting for people to call them, they should contact the other people first.
A medical billing specialist wants to be a person who has answers, especially when other people in your practice need those answers. When they have questions instead, a medical billing specialist should take it upon themselves to seek the answers rather than waiting for them to fall into their lap.
A career in medical billing isn't for everyone. But if you're looking for a career in the healthcare field that lets you advocate for patients, work with a team while remaining independent, and use software to adapt to different circumstances, this may be a good choice for you.
It's not hard to be a good medical billing specialist as long as you care about your job and the people you serve. Many of these qualities are good not only for the workplace, but for having a healthy personal life as well.
Did this guide to making a good medical billing specialist interest you? Ready to get a degree or diploma in billing and coding? A medical billing & coding specialist ensures procedures are properly covered through insurance claims. The medical billing & coding specialist is integral to the smooth operation of any health care facility. Daymar College offers Online Medical Billing & Coding diploma and Associate degree options that make it even more convenient to become prepared for this important profession.
Contact us to learn more about how you can get a rewarding career as a medical billing specialist.