When you visit a doctor and get provided with services, the doctor will then have to submit a bill to the insurance company (if you have insurance) in order to get paid for his or her work. Of course doctors don’t actually do this themselves, this is usually handled by medical insurance billing and coding specialists. The process of turning the doctor’s into billing codes and submitting these to the insurance companies is called medical claims billing.
So how does medical claims billing work? Well, once the doctor has finished documenting the visit, the medical record goes to the insurance billing and coding specialist that works in the office (or to a contract firm that does the work for the office) and the specialist translates the different procedures into the appropriate billing codes required by the insurance companies. These codes are then used to submit bills from the doctor’s office (or hospital) to the insurance company. Each code translates to a specific procedure and each procedure is billed at a certain rate depending on the insurance company and policy that the patient has.
Medical claims billing is a growing field, and it actually does not have a very long training period. You can attend schools that offer one year certificate programs if you are in a hurry to get started, or you can spend a bit longer to get more training and receive a two year associates degree. Many training programs are available through community colleges, as well as online. Just make sure that you do the research and choose one that is accredited and that will give you experience working with both inpatient and outpatient records so you will be well prepared to get started working once you have finished the program. It is a good idea to choose one that prepares you for one of the certification exams.
You can increase your chances of getting a job quickly and getting better pay rates by taking one of the exams to become certified. There are a number of certifications available, including the Certified Medical Reimbursement Specialist (CMRS) certification available from the American Medical Billing Association. Usually they require you to pass an exam after having completed an accredited training program. Some might require you to have a certain amount of experience before taking the exam.