What Does a Medical Billing Specialist Do & Does Your Practice Need One?

Your practice is, first and foremost, a place for healing. However, it’s also a business, and businesses must turn a profit to stay viable.

Efficient medical billing means managing invoices, payments, and insurance claims to ensure accurate and efficient billing. By reducing the risk of financial errors and denied claims, you can speed up payment collection and boost your revenue.

You can hire a medical biller to handle your practice’s billing, but is it worth the money, and what do these staff members do? Here, we explain what medical billers do, how to determine if your practice needs one, and how software like Weave Payments can simplify patient billing even more.

What Does a Medical Billing Specialist Do?

Medical billing and coding specialists are medical records and health information technicians. Many practices merge medical biller and coding responsibilities within a single position, often for budgeting reasons. However, they are technically two different functions, each with a separate job description.

Tasks and Responsibilities of Medical Billing and Coding Specialists

Medical billing specialists are liaisons between medical practices and insurance companies. The responsibilities of a medical billing specialist include:

• Preparing invoices, insurance claims, and financial documentation
• Verifying health insurance coverage and eligibility for medical services
• Submitting patient claims for reimbursement to insurance companies
• Billing patients for out-of-pocket expenses
• Working with patients to set up payment plans
• Tracking payments and following up on late payments
• Verifying, correcting, and disputing denied claims
• If necessary, working with collection agencies to collect outstanding payments

Coding specialists input the correct procedural, service, treatment, and diagnostic codes for record-keeping and billing purposes. These codes ensure proper billing by telling the insurance provider how much they need to reimburse the healthcare provider. The job description of a medical coding specialist includes:

• Being familiar with service, treatment, diagnostic, and medical procedure codes
• Entering correct medical codes in the electronic health record system
• Updating patient records as needed
• Reviewing and verifying patient documentation

Skills, Knowledge, and Training Requirements

The main requirements for medical biller and coding specialists are very similar. These include:

Knowledge of Industry Codes

Familiarity with healthcare industry codes is paramount for medical billing specialists. A medical biller must understand the codes, even if someone else is responsible for the coding, because they verify the codes before submitting insurance claims. The main medical coding systems are:

• International Classification of Diseases (ICD-10): These World Health Organization (WHO)-defined codes identify medical diagnoses.
• Current Procedural Terminology (CPT®): CPT® codes designate specific medical procedures and services.
• Healthcare Common Procedure Coding System (HCPCS): This system includes codes not covered in ICD-10 and CPT®, such as codes for non-physician services and certain medical devices or supplies.

Medical Coding Certificate

Not every medical billing job description requires industry certification. Still, many medical biller and coding specialists who aim at more senior or supervisory positions in their medical coding career choose to undergo the Certified Professional Coder (CPC®) coding program by the American Academy of Professional Coders (AAPC).

Those who pass the certification exam but don’t have the required professional experience can get a provisional CPC Apprentice (CPC-A) certification. To upgrade to full certified coding specialist status, they need to submit proof of either:

• Two years of professional experience; or
• One year of professional experience plus a coding prep course of 80 contact hours

Another popular option is the National Healthcareer Association’s Certified Billing & Coding Specialist (CBCS) certification. In addition to passing the CBCS Exam, candidates must have one year of supervised work in the medical billing and coding field.

Familiarity with Medical Terminology

Billing specialists and medical coders must understand medical terminology, including anatomical, physiological, diagnostic, and procedural terms.

Computer and Office Equipment Skills

Medical billers and coding specialists must be skilled in working with medical billing software. They also need to have a working knowledge of computer and health information management systems and standard office equipment, such as printers, copiers, scanners, and phone systems.

Basic Math Skills

Most billing systems fill out patient forms automatically, but billing and coding specialists may still have to calculate patient co-pay and outstanding amounts or set up payment plans.

Communication Skills

Following up with patients on late payments and disputing denied claims with insurance companies are standard responsibilities for these positions, so good communication is essential.

Do Medical Thought-Leaders use a Medical Billing Specialist?

	We used an internal biller and then converted to a billing company who is paid on an “eat what you collect” model. Standard rates for a billing company range between 4-8 percent depending on the amount of collections. Regardless of which system you use, a 3rd party clearinghouse must still be utilized. – Jay Shorr, MBM-C
	Most veterinary practices do not offer in-house billing for services except in unusual circumstances. In-house receivables are typically managed through a practice management software. On occasion, an outside company like VetBilling or Payment Banc will be used for drafting payments. CareCredit is commonly used. – Debbie Boone, CVPM

Benefits of Hiring a Medical Billing Specialist

A medical biller can be a great addition to your practice staff. Here are some ways a billing and coding expert could help streamline your business administration:

Access to Specialized Billing Expertise

Many small and medium-sized practices delegate billing and medical coding tasks to miscellaneous staff. This often results in reduced productivity and costly administrative errors.

When you hire a dedicated specialist, you have a single point of contact for all billing and coding matters. Other staff members can focus on their own responsibilities, and you get peace of mind knowing that a trained expert is handling all your billing, payments, and claims.

Reduced Risk of Denied or Delayed Claims

Professional billing and coding specialists understand the various rules and regulations on eligibility, requirements, permissions, documents, billing and coding formats, and more. They also keep up with the ever-changing regulatory framework, including Medicare, Medicaid, and the Affordable Care Act.

All this helps ensure continued compliance and minimizes the risk of errors and insurance denials. If you do get a denial, a professional medical biller would know how to handle the rejection, making corrections and following up with the insurance company in a timely manner.

More Time and Resources for Patient Care

As a medical practitioner, billing and coding are likely not your core competencies. By hiring a dedicated biller, you’ll be free to focus solely on diagnosing and treating patients. Your other staff will also be able to focus on their core duties.

Downsides of Hiring a Medical Billing Specialist

For all the potential benefits of hiring a medical biller or coding expert, this move also has its downsides.

The Costs Can Be Prohibitive

According to Payscale, the average medical biller hourly rate as of January 2023 is $17.69. Total salary ranges between $29,000 and $49,000 per year and can go even higher based on experience, training, and geographical location. Depending on the size and budget of your practice, you may or may not be able to create a new full-time position at these rates.

Finding and Retaining Qualified Staff Is Challenging

Staffing rates in the healthcare industry are currently at a historic low due to the combined effects of the COVID-19 pandemic and various economic factors. According to the American Hospital Association (AHA):

• Hospital employment has dropped by nearly 94,000 since February 2020.
• Vacancies for nursing personnel grew by up to 30% between 2019 and 2020.
• Staff turnover has increased from 18% to 30% in some departments.

Smaller medical practices have been experiencing staffing shortages too. A recent survey by AMN Healthcare found that nearly every medical facility—including hospital systems, independent hospitals, laboratories, home health facilities, and more—struggle with professional shortages. In this economic climate, finding and retaining a biller can be challenging.

You’ll Depend on a Single Person

The downside to having a single point of contact accepting 100% of the billing accountability is that you’ll be relying on one person for all billing and coding tasks. This can be a problem in an emergency or a short-notice resignation. You’ll want a backup plan to ensure that insurance claims and payments continue without interruptions.

Is a Medical Billing Specialist Right for Your Practice?

Not all medical practices need a dedicated position for billing and coding, but some do. The tips below can help you determine whether a medical billing specialist would be a good fit for your office.

Evaluate Your Current Billing Process and Staff Capabilities

If you answer yes to two or more of the questions below, hiring a billing specialist might be a good idea.

• Is your staff struggling to understand or keep up with the regulations for insurance reimbursement?
• Is your staff frustrated with billing and coding procedures such as form submissions, disputing medical claim denials, tracking payments, and following up with patients?
• Do you get frequent insurance claim denials despite spending a lot of time and resources on billing and form submissions?
• Are billing errors resulting in reduced cash flow or slow business growth?
• Are staff members less efficient or neglecting their core duties because they spend too much time billing?

Calculate the ROI of Hiring a Billing Specialist

For some practices, the costs of hiring a dedicated billing specialist could outweigh the benefits of reducing denials and speeding up collections. In addition to the wages, bonuses, and other expenses associated with full-time employment, you also want to consider the initial recruitment, training, and onboarding costs. If you’re not losing out on a significant amount of revenue due to denied claims and inefficient collections, hiring a dedicated billing specialist might not be worth it.

Explore Alternative Billing Methods

There is more than one way to streamline your billing and payment processing.

Weave Payments is our proprietary, secure, turnkey payment processing solution for medical practices that allows you to collect more payments with less effort.

The software supports all popular contactless payment methods. Your patients can pay however they want, whether they are in your medical office or thousands of miles away. They can choose to:

• Tap, swipe, or dip their cards.
• Enter their card details manually.
• Keep a card on file.
• Click a text-to-pay link to pay online using any device.

Weave Payments integrates with a state-of-the-art communication platform that streamlines patient communication and automates payment collection post-care. Instead of calling and emailing patients to pay their medical bills, you can simply text them their invoice with a personalized message and a click-to-pay link.

You can also use Weave Payments to set up payment plans. The built-in integration with Sunbit enables patients to spread payments in multiple installments over time.

Expert Tips on Improving Your Billing

	Never blindside your clients. Cost of care should be discussed immediately when the pet is diagnosed. There should be transparency in pricing and options to help clients afford their pets care in place and clients should be informed that they are available. – Debbie Boone, CVPM
	Make sure you can accept credit cards and e-payment systems such as Zelle and Venmo. This makes it easy and can be deposited directly into your account. – Jay Shorr, MBM-C

Streamline Billing and Speed Up Payment Collection with Weave

The answer to “what does a medical billing specialist do, and do I need one?” will depend on your practice. Perhaps your staff can handle the medical coding, but if you want a dedicated medical biller to take on that responsibility, you may increase revenue by avoiding errors that lead to claim denials. 

Whether or not you hire a medical coder, your practice can streamline billing and payments with Weave Payments. 80% of practices report collecting payments faster after adopting Weave Payments. But faster payments and streamlined billing are just the beginning—our platform has more to offer.

Schedule a free demo to see Weave in action and learn how it can transform your medical practice.