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Maria Triebitch

Hiring a Medical Office and Billing Specialist can dramatically increase efficiency and accuracy in the healthcare industry's medical invoicing process. Expertise in medical coding, reimbursement, and data management, as well as familiarity with medical billing laws and compliance requirements, all contribute to better patient care.

Streamline Medical Billing

Healthcare businesses that hire medical billing professionals may ensure that medical claims are submitted accurately and on time, for a faster reimbursement process. They can also help reduce billing errors that result in claim denials and late payments. Given the importance of medical billing and its impact on the financial health of a healthcare organization, the role of a medical office and billing specialist is vital in ensuring that the medical billing process operates smoothly and successfully.

Guide to Maximizing Efficiency

We've outlined the advantages and processes for employing a medical office and billing specialist, including their experience in medical coding, compliance, and reimbursement and their ability to streamline the medical billing process. By reading this guide, you will discover everything there is to know about how hiring medical billing specialists may benefit your business.

What does a medical billing specialist do?

Medical Office and Billing Specialist: Job Description

A Medical Biller manages the billing insurance and processing of payments for clients. They prepare and submit claims for medical procedures and services provided to insurance companies, communicate with patients about outstanding balances, and collect payments for the provider institution. They must have good attention to detail and ensure that patient medical information is accurate and up to date. They must be able to analyze medical data and use sound judgment. Strong written and verbal communication skills are necessary to work with patients, clients, collection agencies, and insurance companies.

Hiring Medical Office and Billing Specialist: Scope of Work

Medical billers monitor accounts, work with patients to develop payment arrangements, and pursue delinquent accounts. They need an in-depth understanding of billing software, electronic medical records, and medical codes. Excellent written and verbal communication skills are essential, as well as solid problem-solving skills, good organizational skills, and the ability to work with numbers. Medical billers work for physicians, hospital operators, nursing homes, or other healthcare facilities.

Sample List of Responsibilities

  1. Publish all insurance payments, contractual and non-contractual adjustments for assigned carriers by CPT code.
  2. Transfer the outstanding amount to secondary insurance or patient responsibility per EOB protocol.
  3. Ensure correct documentation through audits and coding checks.
  4. Sequence all service codes
  5. Track ICD and CPT code diagnosis and procedures.
  6. Find complex and unique coding scenarios.
  7. Reconcile carrier payments and EOB statements daily.
  8. Follow-up on rejected claims per EOB protocol
  9. Send proper electronic and paper claims, rectify errors, and re-send; submit supplementary claims as needed.
  10. Discuss outstanding insurance and patient balances with patients.
  11. Post all payments, including co-payments, insurance, and patient charges, into EMR software by line item.
  12. Balance payment batches in dollar value and modifications before publishing.
  13. Evaluate physician coding at charge entry to ensure Medicare compliance and correct and timely reimbursement.
  14. Offer phone and in-office patient account customer support to clients and authorized agents following practice standards.
  15. Return accounts receivable calls within one working day to maximize patient satisfaction.
  16. Validate demographic and insurance information in patient registration of the EMR software system at charge entry.
  17. Provide feedback to clients and insurance supervisors to ensure prompt payment.
  18. Inform physicians, supervisors, and subordinates about billing, coding, managed care networks, insurance carriers, and reimbursement.
  19. Follow up on returned claims, correspondence, denials, account reconciliations, and rebills within five business days of receipt.
  20. Submit primary and secondary insurance claims daily via HCFA to ensure prompt reimbursement.
  21. Refund insurance companies and patients per client protocol.
  22. Make sure managed care networks and insurance companies pay contract rates.
  23. Patient registration, charge input, insurance processing, advanced collections, reporting, and ledger inquiry proficiency with EMR software.
  24. Cover Account Managers in their absence to maintain a professional practice.
  25. Keep organized, easy-to-reference information on coding, insurance companies, managed care networks and credentialing.
  26. Keep an organized, efficient, and professional workplace.
  27. Follow HIPAA and Medicare compliance policies.

Benefits of Hiring a Top Medical Billing Company

Nowadays, many hospitals and healthcare facilities outsource their billing services to third-party companies. Increasingly hospitals and clinics are teaming up with outside medical billing specialists instead of handling patient billing in-house. The following are some of how outsourcing your medical claims and billing to a third-party service provider might improve your organization's ability to focus on what you do best while making your billing processes more efficient.

Revenue Growth

Businesses often employ professional medical billing experts to help find and fix billing problems. It could enhance the company's income by facilitating faster reimbursements and decreasing the number of rejected claims.

Compliance With The Industrial Upgrades

Medical claims and billing specialists ensure they are current on the most recent compliance standards and regulations. It helps healthcare organizations provide that they are following the ever-changing rules and regulations.

Upscale Solutions

It is typical for medical claims and billing specialists to have access to cutting-edge technology and software systems. These technologies can help streamline the billing process, increasing efficiency and accuracy.

Streamline Workflow

By helping to automate and optimize the billing process, medical billing specialists may free up staff time and resources, enabling healthcare organizations to focus on other crucial elements of their business.

Specialty-Specific Administrative Support

When it comes to the healthcare industry, medical claims and billing specialists with extensive knowledge pave the way for healthcare institutions to receive outside help and expertise they might not have access to otherwise.

Improved Technical Abilities

By outsourcing to a medical billing service, healthcare facilities gain access to state-of-the-art hardware and software that can significantly enhance the effectiveness of billing operations.

Stay Informed

As the healthcare sector continues to evolve, businesses in the healthcare industry must work with a top medical billing company. Companies that outsource their medical billing can benefit from the insights and knowledge provided by medical billing services to maintain competitiveness and adapt to shifts in the market.

Average Salary and Compensation

The Bureau of Labor Statistics (BLS) of the United States estimates that the average annual compensation of a medical biller is approximately $43,000. However, incomes can range quite a bit depending on several different criteria, such as the level of education and experience a person possesses, the field they work in, and the location of their employer.

Factors Affecting Salary for Medical Billers

For instance, hiring medical billers who work in locations with a higher cost of living or in companies that are more specialized within the healthcare sector may earn more money than the average pay. In general, candidates with advanced education or technical certificates may also be able to command better income. It is because they have more marketable skills.

Determining the Median Salary

The sort of establishment in which a medical biller works, such as a hospital, clinic, or private practice, might affect the compensation they earn. The BLS average is an excellent place to start when trying to grasp the earning potential of this occupation. The income of a medical biller can vary greatly depending on various circumstances, but the average wage is a decent starting point.

How to Hire a Medical Biller

Hiring medical billers can be crucial for healthcare organizations that want to simplify their billing processes and make the most revenue possible. If you work in the healthcare industry, follow this step-by-step method to find a medical biller to join your team:

Step 1: Recruiting

Searching for qualified applicants is the first stage in hiring a medical biller. It can be accomplished with the help of healthcare-focused recruiters or generalist employment portals. An effective job description should be well-written and thorough, highlighting the core skills and duties of the position.

Step 2: Complexity

Think about how involved your company's billing process is and how much experience the medical biller you hire will need. If you work for a large healthcare facility with many different departments and specialties, you may need a medical biller who specializes in billing for your field of choice. Nonetheless, a medical biller with broad experience may be adequate for a modest healthcare facility.

Step 3: Duration

When hiring a medical biller, knowing how long the role will last is crucial. Do you want to work here on a full-time, part-time, or contract basis? You can better target your search for the right individual by knowing how long the position will last.

Step 4: Management

Think about how the medical biller will work with the rest of your team and report to management. Specialists will either have to perform solo or form a group. Will they be working under a supervisor or in a team of administrative assistants? If you're looking to hire a medical biller, finding someone who can fit in with your team and do their job well is crucial.

Step 5: Urgency

Assess how quickly you need to fill the medical billing specialist position. Is this an urgent requirement, or can the timing be negotiated? It can help you organize your search for a suitable candidate and shorten the time needed to fill the position.

Step 6: Headcount

Think about the personnel size of your company as a whole and how the medical biller will fit in. Will this person be the sole medical biller on staff, or will they be joining a team of other secretaries? It can establish the minimum qualifications for the medical biller and how they will mesh with your current staff.

Medical Biller Interview Questions

The interview process for hiring a Medical Office and Billing Specialist involves pre-screening, an initial interview, technical skills assessment, a behavioral interview, a reference check, and a job offer. It is designed to evaluate the candidate's technical skills, experience, and fit for the role. Below is a list of key questions, with sample responses to help you hire the most qualified candidate for the position.

What made you interested in becoming a medical biller?

As a qualified medical billing specialist, I was initially drawn to this field due to my interest in healthcare and the financial side of patient care. I am detail-oriented and organized and possess strong analytical and problem-solving skills, which are critical to succeeding in this role.

What medical billing specialties do you have experience with?

I have experience with various medical billing specialties, including physician billing, hospital billing, and ambulatory care billing. I have also worked with multiple medical billing software and have experience in both in-house and outsourced billing.

How do you ensure you follow HIPAA regulations while managing patient records?

I always adhere to the latest guidelines and regulations to ensure that I follow HIPAA regulations while managing patient records. I also stay up-to-date with changes and attend training sessions to ensure my knowledge is current.

How do you handle a patient that is upset about the payments they’ve received?

When dealing with a patient upset about their payments, I listen to their concerns and offer solutions that work within their financial means. I approach the situation with empathy and understanding while also keeping in mind the need to maintain the financial stability of the healthcare provider.

What medical terminology are you familiar with?

I am familiar with various medical terminology, including anatomical terms, medical conditions, and pharmaceuticals. This knowledge is essential for accurate medical coding and billing.

Have you earned any medical billing or coding certifications?

In addition to my experience, I have earned medical billing and coding certifications from recognized organizations such as AAPC and AHIMA.

What’s the difference between deductibles, copays, and coinsurance?

Deductibles, copays, and coinsurance are different types of cost-sharing that patients may be responsible for paying. A deductible is an amount that a patient must pay before insurance starts to cover costs. A copay is a fixed amount a patient pays for a particular service, such as a doctor's visit. Coinsurance is the percentage of costs a patient is responsible for paying after the deductible has been met.

Reach Out To The Experts At Pharmbills

What is a Medical Billing Company?

Medical billing companies, like Pharmbills, help doctors and hospitals manage patient claims and billing. Hospitals, clinics, and private practices hire our experienced and skilled medical claims and billing specialists to file insurance claims, follow up on rejected claims, and manage patient invoices and payments.

How Pharmbills Helps

With our high-end solutions, experience and technical skills, we can help you improve your workflow, manage your revenue cycle, reduce administrative work, and meet industry standards. We help you take your healthcare organization through a simple onboarding process to lay the path for a successful partnership.

Onboarding Process

1. Conduct an exploratory meeting with the Pharmbills medical billing specialist team to discuss your needs, requirements, and expectations. During the consultation, you can ask questions, talk about your needs, and ensure the medical billing service can meet them.

2. Provide access to information about patients and billing, such as EHRs, ICDs, insurance information, and more. Introduction to your accounting department at this point helps ensure this information is available and current.

3. Brief on your organization’s workflow down to specific billing processes, procedures, and software. You may need to give the staff access to training materials or hold training sessions to ensure they understand what is expected.

4. Run tests before going live. Test the Pharmbills' medical billing specialist staff on meeting standards of performance. We recommend running this test together to make sure everything works well. Once testing is done, the changeover to the Pharmbills medical billing team can begin.


How Pharmbills Supports Your Healthcare Facility

Outsourcing your medical billing process can be a big move for any medical practice, but we're optimistic that working together will improve your technique and save you time and money. During this onboarding process, we will explain our method, our policies, and how we can assist you in reaching your financial objectives.

Modernizing Healthcare

Healthcare providers can maximize the value they provide to their patients and spend less time on administrative duties by outsourcing their medical billing. In addition, medical invoicing services have the resources and knowledge to track the ever-evolving regulatory landscape and keep their clients in full compliance. Medical practices are increasingly turning to third-party billing services to stay competitive in today's healthcare market and provide the best possible treatment for their patients.

Reducing Complexity and Stress

Accurate and efficient handling of medical claims takes time, effort, and focus. A medical practice risks losing income and compromising patient care without a devoted team of experts with the knowledge and experience to handle the complexities of medical billing. Medical facilities should consider teaming up with Pharmbills to manage the volume precisely and efficiently.


Improved Billing Speed And Accuracy

Third-party medical billing firms can help healthcare facilities increase income, comply with industry upgrades, streamline workflow, provide upscale solutions, and provide specialty-specific administrative support.  

Faster Reimbursements, Fewer Rejected Claims

Pharmbills’ Medical Billing Specialists are trained on best practice and compliance and certified to use cutting-edge software to automate and optimize the billing process, saving staff time and resources thus, allowing healthcare providers to concentrate on patient care. 

Book a FREE Consultation Today

Suppose you need help with a backlog of medical billing tasks and want to improve the workflow of your medical office; consider engaging a medical billing expert at Pharmbills. Get the support you need to focus on what you do best – delivering excellent patient care. Feel free to ask Pharmbills about building your very own specialist team to streamline your billing process. Book a free consultation today to learn more about how we can help.

Table of Contents


Mariia Treibitch
Reuven Kogan
Sia Malyshenko
Customer Success Manager
Peter Druchkov
Onboarding Specialist

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