Chapter 1 Introduction to Professional Billing and Coding Careers

1. Chapter 1 Introduction to Professional Billing and Coding Careers

2. Introduction to Billing andCoding Careers • Many opportunities can be found for the professional healthcare reimbursement specialist.

3. Facilities • Physician's practice • Solo practice: Single physician • Small group practice: 2-3 physicians • Large group practice: 4-5 or more physicians

4. Hospitals • Patient account services facility (PAS) • Centralized billing office (CBO)

5. Job Titles and Responsibilities • Medical Office Assistants- may also be known as an administrative medical assistant, secretary or medical receptionist. • Usually work in physician's offices and are considered front office staff administrative duties

6. Job Titles and Responsibilities • Medical Billers- handle submission of insurance claims, data entry, and contacting insurance companies regarding incorrectly paid claims • Medical Coders- conduct research and reference check of medical records and are responsible for accurate coding of the primary/secondary diagnoses and procedures

7. Job Titles and Responsibilities • Registered Health Information Technician- may also be referenced as coder, file clerk, health information clerk, medical records director, medical records technician or office manager • Compiles, processes, and maintains medical records

8. Job Titles and Responsibilities • Payment Poster - generally reads the Explanation of Benefits documents issued by insurance carriers and posts the payments or contractual adjustments to the appropriate patient account • Medical Collector- contacts patients and insurance carriers to collect money owed to the medical facility

9. Job Titles and Responsibilities • Refund Specialist - analyzes patient accounts to discern whether or not a refund is required, and if so, to whom the money should be returned • Insurance Verification Representative- contacts insurance carriers to verify benefit information for patients. May also perform precertification and/or prior authorization of service duties.

10. Job Titles and Responsibilities • Admitting Clerk- responsible for registering and greeting patients, having patients complete paperwork, answering questions, data entry of patient demographic and insurance information, and requesting information and payment

11. Job Titles and Responsibilities • Patient Information Clerk- responsible for answering questions about and explaining HIPAA privacy regulations, living wills, DNR orders, and other information to patients and their family members

12. Reasons for Obtaining Certification • Stay current in your field. • Excellent addition to your resume • Professional journals/newsletters • Networking

13. Organizations that Offer Certification to the Medical Office Specialist • American Health Information Management Association (AHIMA) • American Academy of Professional Coders (CCPC) • National Center for Competency Testing (NCCT) • National Healthcareer Association (NHA)

14. Certifications • Medical office assistant certification • National Certified Medical Office Assistant • Certified Medical Administrative Assistant • Medical billing certifications • Certified Medical Billing Specialist

15. Certifications • Medical coding certifications • Certified Coding Associate • Certified Professional Coder • Certified Professional Coder- Hospital • Certified Coding Specialist • Certified Coding Specialist- Physician • Medical records certification • Registered Health Information Technician