Career Story: Billing Coder At A Family Planning Clinic

Billing Coder At A Family Planning Clinic

Job Title: Medical Billing Associate

Type of Company: Non-Profit Family Planning clinic.

Education: Certificate, Medical Billing & Coding, Clark University •• AA, Medical Assisting, Middlesex Community College •• BS, Health Administration, UMass-Lowell

Previous Experience: I worked for an insurance company doing data entry of medical claim forms. Then I contracted at a hospital entering the charges for patient visits into their system. I am currently doing medical billing at a local clinic where I generate patient claims, post insurance payments and also do pharmacy billing and payment posting.

Job Tasks: I primarily bill patient visits to all types of medical insurance companies: Blue Cross-Blue Shield, Tufts Health Plan, United Health Care.... to name a few. I am also responsible for billing all contraceptives dispensed to patients via their pharmacy insurance.

On a daily basis I review patient visit data and create electronic claims. These get sent electronically to the insurance company. I also apply payments from those insurance companies to the appropriate patient account.

I locate all encounters in which contraceptives have been dispensed and bill those to the pharmacy insurance companies. When checks are received, I post the appropriate payment to each patient's account.

When insurance claims are not paid or when they're denied, I have to determine the reason for the denial and determine if I can correct and re-submit the claim. Examples of denials are: incorrect diagnosis code for the procedure that was performed; the medical insurance ID number is incorrect; the patient's name does not match the name the insurance company has; the date of birth of the patient does not match the date the insurance company has and there are many many other reasons insurance companies will deny claims.

Medical billing requires a lot of attention to detail, as well as persistence and patience. This type of position is best learned inside a small billing department. I have had the opportunity to learn about billing, unapplied payments (payments patients pay which have not been credited to their accounts), posting insurance payments, pharmacy billing and payments, etc. If I were in a large hospital my work would be far more specialized.

Best and Worst Parts of the Job: The part of my job I like the least is reviewing each patient encounter and generating the claims. I find this very tedious. Posting the payments received is more interesting.

The best part of my job is the pharmacy billing. I get to run a report in our billing software to locate the contraceptive encounters I need to bill. Then I look in our software to get the insurance information and policy number. Next I go into the pharmacy billing system, enter the patient name, date of birth, policy info, then create a prescription and bill the pharmacy insurance company. When I receive pharmacy payments, I sometimes need to go to the pharmacy system first to identify the patient before actually posting the payment in our billing software.

Job Tips: A career in medical billing and coding must start with a certificate program or associate program. There are many different programs out there both in classrooms and online. My suggestion would be to go to a class. Check the program out. I have heard of people going through a program only to be extremely disappointed in the classes and the money they spent.

Once classes are done, you should probably take an externship (this is an internship that's done once your classes have been completed.) No matter how much you want to get into medical coding, do your internship in billing. I learned this the hard way. I did my externship in coding and was unable to obtain an entry level position in that hospital (there were no openings). After two years, I have finally gotten into a billing position.

Just remember to 'never say no to learning something new'. This will earn you excellent points no matter what field you go into.

Additional Thoughts: This was a career change for me. I worked as a Quality Assurance Test Engineer (testing computer software) for 19 years when I changed careers. It has been a struggle, but so much less stress!

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