What does a Medicare Biller do?

B. Miller

A Medicare biller is one who works in a hospital or physician's office, submitting claims to Medicare on behalf of patients. This job is similar to any medical billing job, where the biller is responsible for entering the proper information and diagnosis codes on various forms sent to insurance companies. A Medicare biller, however, must have more knowledge of particular Medicare codes and laws in order to properly submit the bills and receive payment.

A Medicare biller is one who works in a hospital or physician's office, submitting claims to Medicare on behalf of patients.
A Medicare biller is one who works in a hospital or physician's office, submitting claims to Medicare on behalf of patients.

A Medicare biller generally is not required to have any specific education beyond a high school diploma or GED, though some larger offices might want an associate's degree or certificate from a vocational school in a related field, such as medical office management. Training is usually provided to a new employee once hired. It is important for someone who wants to become a medical biller in an office to have excellent computer skills, feel comfortable working with online forms and electronic filing systems, and to possess a strong attention to detail. An employee working with medical insurance claim forms must always behave ethically as well.

Once a physician becomes a participating physician in the Medicare reimbursement program, all fee schedules for the services offered must be accepted.
Once a physician becomes a participating physician in the Medicare reimbursement program, all fee schedules for the services offered must be accepted.

Medicare has more rules, regulations, and specific processes that must be followed as compared to a standard insurance company. It is important for a Medicare biller to know and understand all of these regulations, both to submit claims properly, and to answer any questions from patients if necessary. Medicare billers who work in larger hospitals or offices may never interact with patients face-to-face, but some billers in a smaller doctor's office may need to assist patients in completing claim forms or answer questions.

Medicare is a federally administered program that provides health insurance for people over the age of 65.
Medicare is a federally administered program that provides health insurance for people over the age of 65.

Once claim forms have been correctly completed and submitted, a Medicare biller will need to follow up on other claims to be certain that they are being processed correctly. If more information is needed, or if there is a problem with a claim, the biller will need to supply the extra information or correct the claim. In addition to his or her work with Medicare billing, a biller in an office might need to complete insurance claim forms for other companies as well, help to maintain a filing system, answer phones, and perform other office and administrative tasks as assigned.

Typically, Medicare billers work fairly regular full-time hours. The job can be fast-paced and stressful, so good time management is important. A successful Medicare biller may be able to become an office supervisor or a manager of a billing department.

The Medicare program helps cover the cost of prescription drugs for elderly individuals.
The Medicare program helps cover the cost of prescription drugs for elderly individuals.

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