A medical biller responsible for claims submission plays a vital role in the healthcare revenue cycle by ensuring that healthcare providers are accurately and promptly reimbursed for services rendered. Accurately compiles and submits medical claims to insurance companies, government payers, or third-party administrators using standardized coding and billing formats (e.g., CMS-1500, UB-04). Collaborates with medical coders to ensure that diagnosis (ICD) and procedure (CPT/HCPCS) codes are correctly applied and compliant with payer requirements. Monitors payer-specific deadlines and submits claims within required timeframes to avoid denials or delays in reimbursement. Utilizes electronic health record (EHR) systems and clearinghouses to transmit claims efficiently, while also handling manual submissions when necessary. Identifies and corrects claim rejections or edits flagged by clearinghouses or payers before resubmission. Adheres to HIPAA regulations and payer-specific billing guidelines to ensure data security and regulatory compliance.
