These guidelines will benefit your work as a health claims specialist
Medical billing and coding professionals have a lot of responsibilities in a healthcare provider setting. They are responsible for handling the reimbursement forms that are sent to health insurance companies, so the practitioners can be reimbursed for the care they provide to patients. This requires attention to detail, thoroughness, and an ability to follow through, as well as familiarity with the codes for diagnoses and procedures (and/or where to find them).
You can get a sense of the duties this position involves, and there are some strategies that apply to any billing and coding position, and can make the work more efficient. Follow these guidelines and you’ll be in a good position with regards to your workload, your colleagues, and the patients you serve.
Double check details of insurance benefits
You never want to be surprised after the fact—i.e., after a patient leaves the office—so it’s a good idea to reach out to an insurance company with any questions while the patient is in the office. You can verify what co-insurance the patient might be required to have, if there are any copayments they must make, and what deductibles the patient might still owe on their plan. This way, you’re in the position to collect any necessary payments from the patient at the time of the visit.
Gather info about necessary pre-authorizations
If the patient’s insurance requires pre-approval for any procedures that he or she is planning to have, it’s a good idea to confirm this with the insurance company well in advance, so you and the patient have time to make the necessary arrangements.
Get a copy of essential patient information
There is some information that you should always have before the patient leaves your sight: basic demographics (age/contact info/social security no./etc.) and a copy of the patient’s insurance card. These will come in handy when you need to choose a code for the reimbursement form. Some offices will also require patient identification—either via a driver’s license, or other state-issued ID. Confirm what your employer prefers, and follow that protocol consistently. (Most offices keep a copy of patient identification on file; see if your supervisor will let you implement a plan like this, if one doesn’t already exist.)
Kill them with kindness
There will be times when you’ll send a claim form out for reimbursement, and it will get lost in the void. This will require a series of emails and phone calls to track it down and get it back in the right person’s hands. You’ll find that total professionalism on your part, and some very good manners, will go a long way in getting cooperation on the other end. Remember that those people, too, are dealing with a high volume of claims. If you can help them to think of you as a member of their team—with the same objective: to resolve this claim efficiently—they’re more likely to help you. Being curt and irritated with anyone, but especially with staff members at a company you’ll be dealing with again and again, is not appropriate. It’s also not effective.
Equipped with these suggestions, you can go forward in your billing and coding practices confident that you’re putting your best foot forward. All of us in healthcare are grateful for the important services you provide!
This post is part of the weekly blog of the American College for Medical Careers. Find out about the professional training programs we offer at our Orlando, FL campus. Reach out to us for more information, or arrange a visit!