Professional Billing Summary

Medical billing and coding specialists usually work in office settings. A computer, a telephone and appropriate documents are all used on a daily basis. Unlike other medical professions, there is little contact with patients. Medical coders work closely with healthcare providers and insurance carriers to gather and provide accurate billing information, but most communication take place in the form of phone conversations and mailings.

"Medical coding professionals provide a key step in the medical billing process. Every time a patient receives professional health care in a physician’s office, hospital outpatient facility or ambulatory surgical center (ASC), the provider must document the services provided. The medical coder will abstract the information from the documentation, assign the appropriate codes, and create a claim to be paid, whether by a commercial payer, the patient, or CMS." (Aapccom, 2015) It is very important that billing coders have a full understanding of how to properly use medical codes to prevent denial of claims submitted.

Inspect and manage medical records to insure that the correct information is being used for the right patient.

Long working hours and a load of responsibilities required on a daily basis. Abduallhi is responsible for handling human resources that include clerical duties, finance, billing, management, scheduling, training, and hiring. Handles finances, calculates and issues patient bills. Assign schedules and tasks to employees, nurse visits, and follow-up. Communicating with each patient’s physician, requesting prior authorization of patient’s illness and injuries in order to understand the right plan of care required for the patient, employee verifications of licensing and certifications requirements like CPR are required to obtain. He also is responsible for all patient clinical records and privacy rights, following compliance policy rules and regulations (laws) of the city and state procedures required of the agency. He must also follow-up with Central Ohio Agency on Aging, Medicare, and Medicaid to keep patients up-to-date about their medical

They are responsible for monitoring HIM compliance program operation, educating HIM professionals, and conducting training activities for all staffs, including providers, clinical professionals, financial personnel, coders, and HIM staffs...They ensure that the compliance standards are deliver properly to all employees, especially HIM staffs, to prevent inappropriate manners in documentations and coding. They usually investigate and compare the payment that organizations receive based on the utilized codes to national trends to determine the dissimilarity. From that information, they could develop needed steps to address any issues. They often work with billing and clinical departments to examine the denial claims, which involve coding, to formulate plans that will avert the problems’ recurrence. HIM compliance specialists assure that entire organizations’ employees’ activities adhere to regulation standards. They will report and recommend actions for compliance breaching to compliance officers. Additionally, they are experts on ethical knowledge, so they are the sources for all staffs to obtain information about compliance manners (Healthcare compliance,

Clerical work will also be included a long with their medical work. They may set patient appointments, greet all of the patients as they come for their appointments and sometimes even be required to do a little bit of bookkeeping. Charts and files are maintained by the assistants and most of the phone duties are

For Medical Billers they will submit and follow up on any claims in order to receive payment for services from the patient or any health care provider. Both Medical billing and coding workers are the health care professionals in charge of processing patient’s data such as treatment records and related insurance information. Medical billers are in charge of making sure everyone is being billed correctly. Medical Billers interact with insurance companies just as much as Medical Coders. A normal day for a medical biller is day to day operations; prepare all billing for Medicare, Medicate, and all commercial insurance companies. Create electronic files, monitor payments and denials. When creating electric files, when a new customer is sent to you Medical office you will create an electronic folder just for them so everyone’s separate

This position will act to provide administrative support with contract preparation, fiscal responsibilities, and oversee the health educator’s specialist.

Medical billers, on the other hand, process and follow up on claims sent to health insurance companies for reimbursement of services rendered by a healthcare provider. The medical coder and biller process a variety of physician services and claims on a daily basis. Medical codes must tell the whole story of the patient's encounter with the physician and must be as specific as possible in regards to capturing reimbursement for rendered services. By majoring in health care administration I found that this type of coding pertains to my area of allied health. With this type of work, it could be very beneficial for the health care department. Reviewing clinical statements, is something that I watched a healthcare worker do while observing for my internship over break, it can often times get confusing and you have to be very cautious about the work you are

Responsible for the oversight, engagement, integration, and management of all risk adjustment and comprehensive health assessment strategies and programs for HealthCare Partners. Serves an essential leadership role in guiding the clinical policies, practices, and programs of HealthCare Partners with final clinical accountability for the quality and appropriateness of clinical documentation and data integrity. Functions in a critical leadership role in transforming and aligning geographic market practices and the organization’s overall vision of a value-based, clinically integrated system that is committed to care delivery that is patient-centered, efficient, timely, effective, equitable and safe.

As you are aware Jessica Arras has been communicating with Tammy in your office regarding Mr. Stephenson’s billing. After a few revisions Tammy faxed to our office what is to be Mr. Stephenson’s final billing for treatment rendered 10/13/14 to 9/15/15. The total amount billed was $7,415.25, due to the inconsistence in the invoices provided I input the number into excel and the total amount billed is correct. However, I subtracted $37.25, which was billed on 2/20/15 for records and previously paid by Mr. McDonnell’s office on 2/15/15 (please see the attached check). Thus making the total amount billed $7,378.00. Mr. Stephenson’s medpay paid your office directly for service in the amount of $1,890.94 and Mr. Stephenson endorsed a medpay

Have the ability to operate computerized programs and databases such as LEAN and VISTA to retrieve sensitive information and to change demographics. Use Microsoft Office products such as Word, Outlook, Excel, and Internet Explorer as a daily function. Have knowledge of basic terminology to identify customer’s concerns with their hearing – aid. Experienced in scheduling or rescheduling appointments, cancelled appointments, provided follow-ups to ensure the satisfactory of the patient’s date and time of the appointment, and have knowledge of tracking the Electronic Wait List for patients who may have the desire for a primary care team or position that has met exceeded capacity. Received incoming mails and packages from the mailroom and determine

As a billing specialist it is very important to behave. Not following the rules could cause you to get in trouble or even lose your job. Behaving is one of the main rules of any field you never want to in bad mouthing your boss, patients, or coworkers. And it can defiantly haunt you in the future. It is very important to know the difference between verbal and nonverbal communication because you never want to use nonverbal when you are talking to your boss or a patient. Especially when it comes to facial expressions or body movement which can easily be misinterpret. This week was definitely a challenge because I always have the hardest time when there is more than one code. This is something I think I’m going to struggle with until I get a better

•Responsible for keeping, updating, and maintaining client’s records by getting the appropriate paperwork from both the client and the psychiatrist.

The purpose of this focus audit is to review the accuracy of documentation and coding reports.