As medical needs and facilities expand, so does the need for legalities and documentation. Medical billing and coding specialist provides the necessary expertise in maintaining the administrative and business aspects of the health care industry.
Medical billing and coding specialist perform a vital responsibility of all modern health care offices. Whether it is a large hospital, an individual doctor’s medical practice, or anything in between; medical billing and coding specialists are crucial to their functioning. Unless the medical billing and coding specialists do their job, the medical staff at the health care facilities will remain unpaid, the medical facilities won’t have the money to run their centers, and the health care entire system will shut down.
What do Medical Billing and Coding Specialist Do?
The core duty in a medical billing and coding Specialist’s career is to ensure that the medical bills are processed and money is received from the insurance company.
The medical billing and coding specialist studies the medical chart. Then, he allocates the relevant medical billing codes for all the medical services provided, such as the diagnostic medical tests undertaken, medical procedures used etc. He sends these codes to the insurance company for processing the claim and receiving payments.
These codes may be submitted manually or electronically, as required. With the advent of computing technology and the internet, the process is becoming increasingly electronic. Nowadays most of the submissions happen on the internet through online portals that are designed specifically for this purpose. Specially designed software is also used, and the medical billing and coding specialists must be well-versed with the relevant software.
All this use of electronic media has made the medical billing and coding process simpler and cut down on the processing period. At the same time, the process now requires good knowledge of computing and internet usage, and this has leveled the field for young entrants who don’t have the experience but are better at computing skills than the experienced medical billing and coding specialists.
Completing the processing cycle:
The medical billing and coding specialist’s job does not end after the coding is done and claims are submitted to the insurance company. The medical billing and coding specialist must then follow up with the insurance company for release of payment and ensure that the payment is received in minimum amount of time.
In case the claim is denied and rejected entirely or in parts, the billing and coding specialist analyzes why the claim got rejected; and proceeds to re-code and re-submit the bills.
While this is not an official justification; but it is largely believed that the primary difference between an experienced and inexperienced medical billing and coding specialist is not just the speed of coding and claims submission; but it is also the ability to achieve quick turnaround of submitted claims with lower rejection rates.
While one aspect of billing handled by the medical billing and coding specialists is between the health care service provider and the insurance companies, another aspect consists of managing the patient-side billing.
Patient-side billing takes into consideration all the health care services rendered including the diagnostic tests, procedures for treatment, drug prescriptions, follow up visits etc. These details are converted into a professional billing format and sent to the patient. Any amount not covered by insurance and being charged to the patient, is usually mentioned on this bill.
Based on the employer, there might be additional jobroles for the specialist apart from medical billing and coding. These could include patient records filing, records management, client handling, answering phone calls, patient scheduling, receiving and sending emails etc.
Freelance Medical Billing & Coding Specialist Career
One big advantage of being a medical billing and coding specialist is that the professional can work as a freelancer or consultant. The medical billing and coding specialist can setup his home office and find outsourced work from health care service providers. Due to increased use of information technology, the home office model has become even easier. The basic records and data is sent over the internet to the medical billing and coding specialist, who codes the data and submits the bills electronically over the internet to the insurance company for processing.