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Career Story: Billing Specialist At A Doctor's Office

Billing Specialist At A Doctor's Office

Job Title: Patient Accounts Representative

Type of Company: Medical Specialist Office

Education: High School Graduate

Previous Experience: I started as a clerk, typing medical insurance claim forms when I was just out of high school and stuck with the same business.

Job Tasks: My responsibilities include medical coding of claim forms, electronic submission of claims, posting of patient and insurance payments and adjustments and telephone customer service. Other than submission of these medical claims, I am also responsible for follow-up on unpaid medical claims, re-coding of claims based on physician progress notes and when needed using our electronic medical records system. I occasionally fill in as a receptionist making patient appointments, etc.

A typical day consists of posting the previous day's charges/payments from patients in our computer system. This is where reading over progress notes from the physician helps to make sure that all procedures are billed properly with correct diagnoses. After this is done, any checks that have come from patients or insurance companies are posted to the appropriate accounts. I correct insurance claims that have been submitted incorrectly or processed by insurance companies incorrectly and re-bill the insurance company. In between these duties, I field patient phone calls and answer questions. I also review past-due accounts and unpaid medical claims, send out letters to overdue accounts. We also verify eligibility with insurance companies to make sure patients are giving us their current insurance information and referrals if required by their insurance.

Best and Worst Parts of the Job: The best part of my job is to see payments coming in on claims that I have worked hard to code properly to get the best possible reimbursement on.

The worse part is to have to tell patients that they didn't have the full coverage for services that they assumed they had. Many have hidden deductibles they didn't realize they had.

Job Tips: Learning the ins and outs of medical insurance plans is a must, unless you have a "cheat sheet". Many insurance companies do have them to use as a reference. Attend as many insurance seminars and seminars hosted by your software provider to keep up on the latest procedures.

Additional Thoughts: It is usually a fast-paced setting, but a good one. I thoroughly enjoy working in the medical setting, even though I am support staff and not a doctor or nurse. For the most part, patients are very appreciative of the care they receive and are thankful for the administrative help as well.

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