What does a medical insurance billing specialist do?
The medical billing specialist is responsible for all the processing of claims necessary for a provider to get paid. This typically starts with entering the claim information such as patient name, date of birth, address, insurance info, etc. as well as the diagnosis and treatment codes assigned by the doctor or coder. Once the information is entered the insurance claim is submitted – either directly to the insurance company or a clearinghouse. The clearinghouse performs basic error checking and submits the claim to the individual insurance company according to their required format. After the claim is submitted and paid, the payment information must be entered into the electronic medical billing software – also called practice management software. This is shown on the Electronic Remittance Advice (ERA) or Explanation of Benefits (EOB). This includes how much was paid on each claim, the write off, patient co-insurance or deductible responsibilities, etc. If the claim was not paid, the m
