Insurance Handbook for the Medical Office 13 th edition. Chapter 01 Role of an Insurance Billing Specialist. Introduction to Insurance Billing. Identify the background and importance of accurate insurance claims submission, coding, and billing.
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Role of an Insurance Billing Specialist
Identify the background and importance of accurate insurance claims submission, coding, and billing.
Assess responsibilities assigned to insurance billing and coding specialists and electronic claims processors.
Name the office procedures performed during a work day that may affect billing.
Specify the educational requirements for a job as an insurance billing specialist and a coder.
Describe the variety of career advantages and areas of specialization open to those trained as insurance billing specialists.
List qualifications and skills to be acquired by an insurance billing specialist.
State the personal image to be projected as an insurance billing specialist.
Describe professional behavior when working as an insurance billing specialist.
Medical insurance professionals deal with all aspects of claim submission
Two main billing types
Hospitals, rehabilitation centers, etc.
Physician or NPP
Job descriptions will vary for each position in a medical office.
Administrative professionals may be responsible for claims processing, collection of payments, and communicating policies to patients.
Medical terminology and abbreviations, anatomy, physiology, disease, and treatment terms
Medicolegal rules and regulations of various insurance programs
Typing/keyboarding and computer skills
Proficiency in accessing information through the Internet
Billing and collection techniques
Expertise in legalities of collection of accounts
Ability to generate claims with speed and accuracy
Differentiate between medical ethics and medical etiquette.
Specify instances when an employer and/or employee can be liable when billing for medical services.
Identify common practices and limitations of a claims assistance professional’s scope of practice to his or her clients.
Explain how insurance knowledge and medical knowledge can be kept current.
Medical etiquette: how medical professionals conduct themselves
Medical ethics: standards of conduct generally accepted as moral guides for behavior
Billers and coders can be held personally responsible for billing errors
“Errors and omissions” insurance is protection for errors or unintentional omissions
Correct any errors and document in writing
Know billing regulations for all payers
Know compliance rules and regulations
State rules about patient treatment and referrals
Be proficient in computer skills
Learn electronic billing software for each payer
Develop diagnostic and procedure coding expertise
Know how to interpret insurance documents
Attain bookkeeping skills to manage patient/practice accounts
Stay up-to-date with industry news
Cross-train in areas of practice mgmt.
Strive toward becoming certified and seek continuing education