Medical Biller Research Paper

Medical Biller Research Paper

The medical biller are healthcare professionals who translate healthcare service to medical claims. The medical billers assess the healthcare services given to a patient and submit claims to the insurance companies and healthcare players such as Medicaid and Medicare. This position is very essential for the financial cycles of the health care providers form a single provider operation to large healthcare facilities. Thus, to be a medical biller, one needs to have basic knowledge in financial analysis and health operation. This knowledge should be accompanied by high level of analysis and combining concepts.

In this case, the paper will analyze five topics that are essential for research billers. These topics include; the experience and Qualifications for Insurance Claim Processors, job Functions of a Medical Insurance Processor. Workers compensation, submitting claim electronically and common mistakes resulting claim denials will be also analyzed. The Insurance Claim Processor or the claim examiners are healthcare insurance employees who assess the medical claim to decide whether an insurance company will pay the claims. The claim examiner job has no specific educational qualification.

Though many organizations require one to have a minimum of high school college diploma depending on the organization working policy. Most of the organizations offer in job training, though they recommend the applicant to have knowledge in the related field. For this course, various vocational training schools offers various courses related to this field. (Alyson, 2020). In this role, its highly recommend for candidate to take certified medical reimbursement specialists’ exam. Thus, since there no experience required during hiring of Insurance Claim processors, organizations should provide orientation and on-job training.

The Insurance Claim Processor should have good communication skills. The claim examiners should be able to communicate effectively both in writing and verbally. These skills enable them to understand the claim reports, for analysis. The claim examiners should able to communicate feedback clearly to the victim both in writing and verbally. The claim examiners should have good customer service skills such as patience, self-control, critical and logical thinking to help the associate well with clients.

Medical Insurance Processor analyses the validity of medical claims, in the insurance companies to determine whether they are viable for payment. The Medical claims processor managers all the insurance claims from the doctors’ offices. The primary role of the Medical Insurance Process evaluates the claims presented in the insurance companies. They have number of responsibilities that revolve around the verifying whether company should pay the claim or clients losses. The first role is helping the insurer to review the insurance policy agreement to determine the kind of cover if any the claim or loss can be accorded.

The claim processor provides customer services to clients who need guidance on how to file claim or any other help. After verifying the claim and determine its validity, then the claim processor facilitate the forms and paperwork to facilitate the payment. If some of the information is missing, then the claim processors contact the client to provide the additional information. In some cases, the claim processor calculates the payment and pay the client, this is usually case for standard of claim. But for the complicated claims, then they forward the claim to management for investigation.

The Medical claim processor has other administrative role they play when they are not verifying or paying the claims. They claim processor process new insurance and modify the existing policies to ensure they reflect new policies and coverage protocol. Also, they apply insurance rating systems to policies and claims. The primary role of the organization is to provide security to its worker. The effort to ensure worker works in secure environment doesn’t guarantee workers safety, accident to happen.

Organization should have a sound workers compensation policy. The compensations are aimed to facilitate victims’ treatment and pay bills when they cannot report work. In case a worker in covered organization becomes sick get injured due to working environment of incident occur in the organization, the one may qualify for compensation claim (Moore & Viscusi, 2014). Thus, employees should understand workers compensation policy to ensure they receive best compensation package. From the legal perspective all organizations should have sound workers compensation and failure to adhere to this regulation, organization will face legal action.

Workers compensation is very essential part of business benefits package. The work compensation provides security in two fronts. First, the workers compensation protects business legal complication and lawsuits after accident happen. The worker compensation helps to facilitate workers receive healthcare service after accident and also help them to receive some portion of their income until they return back to work. The workers compensation doesn’t consider whose fault was, thus consider all incident as accident.

The advancement of technology has changed many operations in the organizations, from paperwork to electronic operation. Submitting claim electronically is one the effect of technology advancement. Electronic claim submission is paperless victims’ claims that are done through computer software to the health insurer (Wargin, Dahle& Weiss 2012). In this topic there are various concepts that medical biller should understand to improve knowledge. There exist many options that the electronic service providers provide to conduct electronic claim submission, but mainly there are two broad approaches of electronic claim submission – full-service and electronic service electronic claim submission.

Under this approach, the claim is filed by service provider on behave the healthcare provider. The psychologist or the third party only send the basic detail of patient and service to the bailing service. The bailing services develop claims and submit them direct to the insurer. The self-service electronic claims are generated and filed by psychologist direct to the third party or the health service claims clearing websites. The submission is done through the software provided by the player.

Filling healthcare claims electronically offers many benefits to the organization and the patients. Help to reduce disruption of the cash flows; this approach allows quick assessment of results thus, allow faster payment (Wargin.at el, 2012). Benefits are, cut down paperwork and increase the level of accuracy and save time and overhead cost. In some case, medical claims are denied, in some case, it’s not a major error of flaw of the players but small omissions of mistake that occur during claim submission. Thus, in case of claim denial, it’s appropriate to assess the submission instead of blaming the player.

There are some common mistakes that result to denial of claims (Feinman, 2012). Some of the mistake includes the following. The failure of the patient to adhere to health insurer claim policy may result to the claim being illegible and thus, it will be denied. During submitting the claim, it’s essential to check whether required procedure and format is adhering to according to insurer policy. Printed materials are illegible and messy and thus make scanning problematic.

Staffs miss to record some of the encounter in the bailing document; this may affect to claim operations. Insurers are keen to detail and thus, they will quickly notice omission and count such omission as enough ground to reject claim. The insurer may also denial claim due to lack of specification. The late denial is common form of medical claim denial . Player operates in their deadline and schedule; thus, this can make the healthcare provider miss the insurer filing deadline.

The insurer should keep communicating their time schedule to allow healthcare provider to comply with this deadline. The medical biller should have this information in mind to be able to complete their task effectively. The medical claim involves various processes which should be done accurately to meet the insurer policy as well as the standard placed. With increased changes especially in information technology, the medical biller should learn its effect on claim submission.

References

• Alyson, J. (2020). Claims Processor: Jobs and Responsibilities. Retrieved from https://www.example.com/claims-processor-jobs
• Feinman, J. M. (2015). The Law of Insurance Claim Practices: Beyond Bad Faith. Tort Trial & Insurance Practice Law Journal.
• Moore, M. J., & Viscusi, W. K. (2016). Compensation mechanisms for job risks: wages, Workers' Compensation, and product liability. Princeton University Press.
• Wargin, J. M., Dahle, D. R., & Weiss, J. G. (2012). U.S. Patent No. 8,401,896. Washington, DC: U.S. Patent and Trademark Office.
• Wargin, J. M., Dahle, D. R., & Weiss, J. G. (2015). U.S. Patent No. 8,401,896. Washington, DC: U.S. Patent and Trademark Office.