Insurance Companies Hire Medical Billers and Coders - dummies

Insurance Companies Hire Medical Billers and Coders

You may decide that, as a medical biller or coder, you want to work in claims for an insurance company. Working in a medical claims job is one way to stretch the limits of your billing and coding knowledge.

Many insurance companies process their claims by computer. They either receive the information electronically or scan it into their processing software, where it is processed, ideally correctly. To ensure more efficient, yet timely, claim processing, many of these companies also use a claims processor.

To be successful as a claims processor, you need to know medical claim coding, billing procedures, and insurance obligations. These processors carefully examine each claim to determine its validity and accuracy.

The processor then refers to the patient’s insurance policy or plan to determine the level of processing for the claim. The processor also has software that contains the contracts that are linked to individual medical providers by their tax identification number or National Provider Identifier (NPI). They apply the claim to the plan provisions and payer contract to determine payment.

After doing all this, the payment is issued accordingly. If the claim needs additional clarification or information, the claims processor sends a notice to the appropriate office to request the missing details.

In addition to payer-processing positions, insurance companies also need people to handle incorrectly processed claims when the providers appeal them. Again, solid knowledge of medical terminology, diagnosis, and procedural codes are valuable tools for these employees.