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What does a medical biller do?

Medical billers calculate and collect payments for services like procedures, tests or surgeries, and oversee the insurance claims for health care providers.

Where do medical billers work?

Many medical billers work in hospitals or physician’s offices.

Why is certification important to becoming a medical biller?

Becoming certified shows you have obtained the proper training and skillset employers look for in a medical biller.

What is the job outlook for a medical biller?

According to the , the job outlook for medical billers is expected to grow by 8% (faster than average) through 2032, with 194,300 jobs opening annually.

Our Medical Billing course introduces you to health insurance and reimbursement. In this course, you will become familiar with the health insurance industry, legal and regulatory issues, and differences in reimbursement methodologies. You will learn principles of medical billing related to proper claim form preparation, submission and payment processing, and the follow up process. This course is recommended for anyone who is preparing for a career in a medical billing department at a physician’s office, clinic, or similar positions. This course is strongly recommended for anyone who is preparing for AAPC’s CPB™ certification exam.

Course Objectives

• Review an introduction to healthcare from a medical billing perspective.
• List a variety of health insurance models and how they affect medical entities.
• Understand the legal regulatory considerations involved in health care reimbursement and collections.
• Explain the process of a physician-based insurance claim including obtaining patient data, claim form completion, insurance carrier processing and payment received.
• Demonstrate the ability to use the three major coding manuals, CPT®, ICD-10-CM, and HCPCS Level II, and apply medical necessity standards.
• Explain the follow up process for A/R in a physician’s office, including the top denials by insurance carrier along with their appeals process.

The following modules for required training for medical billing certification.

Module 1. Basics of Insurance Billing and Compliance

• Insurance Billing Specialist
• Insurance Claims, Coding, & Billing Background
• Medical Etiquette
• Medical Ethics
• Health Insurance Portability and Accountability Act (HIPAA)
• Fraud and Abuse Laws
• Compliance Programs
• Health Care Reform
• Insurance Policies
• Types of Coverage

Module 2. Medical Documentation and Coding

• The Documentation Process
• Documentation Guidelines
• Electronic Health Records
• Documentation Terminology
• Diagnostic Coding
• ICD-10 Diagnosis and Procedure Codes
• Procedural Coding
• Methods of Payment
• Official Guidelines for ICD-10-CM
• CPT Coding

Module 3. Paper and Electronic Claims

• Paper Claim CMS-1500
• Types of Submitted Claims
• Health Insurance Claim Forms
• Claim Completion Guidelines
• Electronic Data Interchange
• Transaction and Code Sets Regulations
• Claim Management Techniques
• Claim Inquiries
• Filing an Appeal

Module 4. Fee & Insurance Collection

• Claim Policy Guidelines
• Explanation of Benefits
• Medical Review
• Management of Plans
• Plan Administration
• Financial Management
• Cash Flow Cycle
• Accounts Receivable
• Credit and Collection Laws
• The Collection Process

Module 5. Health Care Payers, Part 1

• Private Insurance
• Managed Care Systems
• Medicare Reimbursement
• Claim Submission
• Medicaid Programs and Eligibility
• Medicaid Benefits
• Medicare Policies and Regulations
• Medicare Managed Care Programs
• Payment Fundamentals

Module 6. Health Care Payers, Part 2

• TRICARE Programs
• TRICARE Standards
• CHAMPVA Programs
• TRICARE & CHAMPVA Claims Procedures
• Workers’ Compensation Laws
• Workers’ Compensation Eligibility & Coverage
• Workers’ Compensation Fraud & Abuse
• Occupational Safety & Health Administration Act (OSHA)
• Disability Income Insurance
• Disability Benefit Programs
• Disability Claims
• Federal & State Disability Programs

Module 7. Inpatient & Outpatient Billing

• Hospital Billing
• Patient Accounts Representative
• Admissions Procedures
• Utilization Review
• Coding Hospital Diagnoses & Procedures
• Coding Inpatient Procedures
• Coding Outpatient Procedures
• Reimbursement Process
• Billing Problems
• Hospital Billing Claim Form
• Employment Opportunities
• Searching for a Job
• Self-Employment

Download Course Outline (PDF)

It’s important you know anatomy and medical terminology to be successful. We recommend taking either of these courses from our partners at ed2go to be successful in our Medical Billing course.

Upon successful completion of our Medical Billing course, students will be prepared for an entry-level position doing medical billing in a medical office setting and will be prepared to sit for the to become a Certified Professional Biller (CPB).

Internet Connection

• Broadband or High-Speed - DSL, Cable, and Wireless Connections
• Dial-Up internet connections will result in a diminished online experience. Classroom pages may load slowly and viewing large audio and video files may not be possible.

Hardware Requirements

• Processor: 2GHz Processor or Higher
• Memory: 1 GB RAM Minimum Recommended
• Webcams are strongly recommended.

PC Software Requirements

• Operating Systems: Windows 7 or higher
• Microsoft Office 2013 or higher. Also, you could use a general Word Processing application to save and open Microsoft Office formats (.doc, .docx, .xls, .xlsx, .ppt, .pptx)
• Internet Browsers: Google Chrome is highly recommended
  • Cookies MUST be enabled
  • Pop-ups MUST be allowed (Pop-up Blocker disabled)
• The Kindle Reader App or VitalSource Bookshelf App are needed for many of our courses (No special equipment needed. This can be downloaded for FREE onto your computer.)
• PowerPoint Viewer (if you do not have PowerPoint)
• Adobe PDF Reader
• QuickTime, Windows Media Player &/or Real Player

MAC Software Requirements

• Operating Systems: Mac OS x 10 or higher with Windows
• Mac office programs or a Word Processing application to save and open Microsoft Office formats (.doc, .docx, .xls, .xlsx, .ppt, .pptx)
• Internet Browsers: Google Chrome is highly recommended
  • Cookies MUST be enabled
  • Pop-ups MUST be allowed (Pop-up Blocker disabled)
• The Amazon Kindle Reader App or VitalSource Bookshelf App are needed for many of our courses (No special equipment needed. This can be downloaded for FREE onto your computer.)
• PowerPoint Viewer (if you do not have PowerPoint)
• Adobe PDF Reader
• Apple QuickTime Media Player

Other

• Email capabilities and access to a personal email account.

Susan Gochoco, CPC, CCVTC, CCP, CEMC, CPC-I, has worked in healthcare for over 30 years. She first earned a core coding credential and went on to earn several specialty credentials, including the certified professional biller certification most recently. In 2003, Susan began teaching coding and billing and has worked as an adjunct instructor at Towson University for over seven years. She enjoys teaching and is happy to share her extensive knowledge of healthcare with others. Susan is currently employed as a senior coder in the University of Maryland Medical System Department of Surgery.