Top 15 Billing Specialist Skills (2024)

15 billing specialist skills for your resume and career

1. Patients

Patients are individuals who receive medical care or treatment. Billing specialists use patients to verify insurance information, request prior authorization, and update billing information. They also communicate with patients, insurance companies, and medical facilities. They generate bills and statements for patients, verify benefits and eligibility, schedule dispatches, and review patients' billing statements. They also provide patients with information and assistance regarding medical bills, obtain demographic and insurance information, verify patients' insurance eligibility, and work closely with primary care physicians to ensure accurate billing.

Here's how billing specialists use patients:

Verified insurance information, requested prior authorization for patients from doctors or insurance to establish coverage and medical necessity.
Completed eligibility checks daily and monthly for all patients to assure accurate billing information is updated.

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2. Customer Service

Customer service is ensuring the satisfaction of customers' needs and expectations. Billing specialists use customer service by communicating with patients and insurance companies, resolving complex administrative issues, and providing timely and professional assistance. They also maintain frequent phone contact with provider representatives and pharmacy staff, and create procedural manuals for customer service representatives to ensure uniformity and efficiency.

Here's how billing specialists use customer service:

Provided excellent customer service ensuring expectations have been met in reference to billing, existing services or potential service enhancements.
Verified validity of account discrepancies by obtaining and investigating information from sales, customer service departments, and customers.

3. Data Entry

Data entry is the process of manually or electronically entering information into a database or spreadsheet. Billing specialists use data entry in various ways, such as assembling and maintaining patient charts, processing denials, and performing administrative duties like payroll processing. They also enter information into computer systems for outbound and inbound freight, and verify insurance eligibility. They need to perform data entry accurately, efficiently, and quickly, and ensure that the information is accurate and complete.

Here's how billing specialists use data entry:

Answered telephone inquiries in a timely and courteous manner Utilized data entry skills to maintain customer orders and assured proper processing
Assembled and maintained confidential patient charts containing current personal demographics and review data entry to ensure accurate and complete files.

4. Medical Billing

Medical billing is the process of submitting medical claims to insurance companies for reimbursem*nt. Billing specialists use medical billing to process insurance claims, enter financial transactions into bookkeeping ledgers, and maintain records. They also verify the accuracy of coding to produce comprehensive medical billing and advise physicians on software upgrades and requirements needed for medical billing transitions.

Here's how billing specialists use medical billing:

Recruited into position to assist 6 billing professionals in administrative support functions in a busy, medical billing/insurance preparation office.
Maintained Medical Billing records, entered financial transactions into bookkeeping ledgers, mailed monthly patient statements, maintained Reconciliation Logbook.

5. Medicaid

Medicaid is a health insurance program for low-income individuals and families. Billing specialists use Medicaid to process claims and ensure timely payments. They review patient records to gather billing information and update Medicaid eligibility. They also verify primary and secondary payers, including Medicare and Medicaid. As one billing specialist put it, they "ensured fulfillment of organizations and Medicaid's policies and procedures."

Here's how billing specialists use medicaid:

Maintain up-to-date knowledge and understanding of procedures related to Medicare, Medicaid and third-party insurance billing and reimbursem*nt.
Reviewed work performed and evaluated employee performance to ensure fulfillment of organizations and Medicaid s policies and procedures.

6. CPT

CPT stands for Current Procedural Terminology, a system used to report medical, surgical, and diagnostic procedures and services to payers for reimbursem*nt. Billing specialists use CPT to assign codes to medical procedures and services to ensure that insurance companies reimburse them correctly. For example, they use these codes to verify that medical ICD-9 and CPT coding match the procedures performed, to assign the correct level of service for a patient's procedure, and to ensure that claims are submitted with the correct CPT and diagnosis codes.

Here's how billing specialists use cpt:

Reviewed insurance explanation of benefits and verified medical ICD-9 and CPT coding for accuracy to ensure proper allocation of benefits.
Conducted all CPT and ICD-9 coding for Physicians and Chiropractor office Accounts receivable Filled-in nursing responsibilities

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7. Patient Accounts

Patient accounts are records containing a patient's personal and financial information. Billing specialists use patient accounts to perform routine computations, facilitate the development of patient payment plans, and ensure accurate billing. They review and verify patient accounts and insurance information, and make necessary corrections as needed. They also use patient accounts to determine appropriate refunds, research refunds, and identify patient accounts for billing opportunities.

Here's how billing specialists use patient accounts:

Obtained patient financial status, performed routine computations to facilitate development of patient payment plan, accurately applied payments to patient accounts
Entered and worked collaboratively with patient account department to ensure accurate billing and resolve claim denials and medical-necessity issues.

8. Submit Claims

To submit claims, billing specialists review medical records and other documents to accurately and efficiently process insurance claims. They match medical claims with insurance referrals and authorizations before submitting them to insurance companies for payment processing. This process sometimes involves appealing denied claims, resubmitting claims, and correcting errors.

Here's how billing specialists use submit claims:

Review claims for accuracy and obtained missing information to submit claims electronically to various insurance companies for processing of payments
Match paper medical claims for patient office visits/services with required insurance referrals/authorizations and submit claims to insurance company.

9. Medical Terminology

Medical terminology is the specialized language used in the medical field. Billing specialists use it to ensure accuracy when processing medical claims and procedures. They also use it to communicate with hospitals regarding patients and insurance information, and to translate medical terminology in billing and coding processes.

Here's how billing specialists use medical terminology:

Possessed basic knowledge of medical terminology and diagnostic codes to ensure accuracy of medical claims and procedures.
Performed secretarial duties, utilizing knowledge of medical terminology and hospital, clinic and laboratory procedures.

10. Billing Issues

Billing issues are concerns or problems related to billing, such as incorrect charges or unpaid invoices. Billing specialists use billing issues to provide quality service to customers, identify their needs, and assist them with concerns related to billing. They also submit electronic bills, troubleshoot electronic billing issues, and update managers regularly regarding unresolved billing issues and workload. They maintain positive relations with clients while resolving complicated and contentious billing issues, conduct research, analyze, and complete the resolution of customer billing issues, and assist other departments regarding billing issues.

Here's how billing specialists use billing issues:

Ensured customer satisfaction by providing quality service, identifying customer needs and assisting them with issues/concerns related to billing issues.
Submit electronic bills, troubleshoot electronic billing issues, and update Billing Manager regularly regarding unresolved billing issues and workload.

11. Medical Claims

Medical claims are official requests for payment or coverage of medical services or products. Billing specialists use medical claims to ensure proper evaluation and reimbursem*nt for medical services. They monitor system errors, communicate with insurance adjusters, and verify patient insurance/benefits before submitting claims. They also investigate unpaid claims, process appeals, and follow up on collections.

Here's how billing specialists use medical claims:

Monitored for and resolved relevant system or technical errors directly with insurance adjusters to ensure proper evaluation of medical claims.
Processed secondary and third party medical claims with follow up on collections Verified insurance and authorizations for processing claims

12. Appeals

Appeals are the process of disputing a decision or action. Billing specialists use appeals to dispute denied claims with insurance companies. They investigate the reason for non-payment, set up the appeals process, and provide necessary information and documentation to insurance carriers. They also trace appeals with confirming patient information and eligibility and work with commercial accounts regarding appeals and denial explanations. They prepare responses and documentation for provider/patient appeals and submit appeals along with documentation if requested.

Here's how billing specialists use appeals:

Investigated reason for non-payment, set-up appeals process and provided necessary information and documentation to insurance carriers.
Contacted hospitals for patient demographic information and/or requested and obtained medical records when necessary for appeals.

13. HIPAA

HIPAA stands for Health Insurance Portability and Accountability Act. It's a federal law that sets national standards to protect the privacy and security of patients' medical records and health information. Billing specialists use HIPAA in their job by following the privacy policy and regulations concerning confidentiality and security of protected health information. They also maintain current HIPAA certifications and identify any possible process improvement for communication for billing through analysis. They adhere to all HIPAA guidelines/regulations while handling patient information and confidentiality. They maintain confidentiality concerning clients' protected health information and protect the security of medical records to ensure confidentiality is maintained and HIPAA guidelines are enforced.

Here's how billing specialists use hipaa:

Follow the privacy policy and HIPAA laws and regulations concerning confidentiality and security of protected health information.
Resubmitted insurance claims as necessary knowledgeable in timely filing restrictions are in compliance with HIPAA regulations

14. Insurance Claims

Insurance claims is a process of seeking compensation from an insurance company for a loss or incurred expense. Billing specialists are responsible for reviewing, forwarding, and submitting insurance claims to different insurance companies. They also investigate and resolve issues related to insurance claims and authorizations. They identify and process secondary and/or tertiary insurance claims and maintain insurance claims in collection. They document billing codes and process insurance claims electronically or on paper.

Here's how billing specialists use insurance claims:

Accessed and processed documentation from contracted medical facilities and outside billing companies in order to successfully process insurance claims.
Reviewed for accuracy and forwarded numerous insurance claims with a specific emphasis on behavioral health and occupational medicine clients.

15. EOB

An Explanation of Benefits (EOB) is a document that insurance companies send to policyholders showing what medical services were provided, the cost, and how much the insurer paid. Billing specialists use EOBs to determine responsibility for non-covered or ineligible charges, resolve incorrect payments, and follow up with payments and denials. They also reconcile patient accounts by verifying information on the EOB. For example, they may establish protocols for processing claims, analyze EOB payments and denials, and transfer A/R balance to the appropriate party as per payer EOB.

Here's how billing specialists use eob:

Review non-payment EOB to determine responsibility of non-covered/ineligible charges and post appropriate denial code.
Handle eligibility verification, electronic billing, denial resolution, and EOB reconciliation.

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