chapter 1 introduction to professional billing and coding careers

Comprehensive Health Insurance

Billing, Coding, and Reimbursement

Copyright ©2009 by Pearson Education, Inc.Upper Saddle River, New Jersey 07458

All rights reserved.

Comprehensive Health Insurance: Billing, Coding, and ReimbursementDeborah Vines, Elizabeth Rollins, Ann Braceland, Nancy H. Wright, and Judith S. Haynes

Chapter 1Introduction to Professional Billing and Coding Careers




Introduction to Billing and

Coding Careers Many opportunities can be found for the

professional healthcare reimbursement specialist.




Facilities

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

physicians




Hospitals

Patient account services facility (PAS) Centralized billing office (CBO)




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





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





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





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





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.





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





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




Reasons for Obtaining Certification

Stay current in your field. Excellent addition to your resume Professional journals/newsletters Networking




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)




Certifications

Medical office assistant certification– National Certified Medical Office Assistant– Certified Medical Administrative Assistant

Medical billing certifications Certified Medical Billing Specialist




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

chapter 1 introduction to professional billing and coding careers

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