Billing and Collection: Complete Billing Record Monitoring In Hospitals

Hiring One of the Best Medical Claims Billing Managers Is Necessary for the Success of any Medical Firm

Unpaid claims and rejected claims are always quite an awkward situation for any medical practitioner. There is a solution for these problems and situations; hiring an experienced medical claims billing manager for your firm. These managers are quite different from an ordinary office manager. 

Their functions and responsibilities in their medical fields are quite different from most other officers.

They must have solid experience in the field of billing and collection, as well as the knowledge to back up their experience, and show that they are the right candidate. The candidate should also have a vast amount of knowledge in following fields-

  • Insurance & Payers Policies and Guidelines that include knowledge about what is deductible, out of pocket, coinsurance, as well as knowing the difference between out of network and in-network benefits, all medical necessity, rehabilitation services etc.
  • Medicare and Medicaid policies, guidelines and being able to determine coverage
  • Knowledge of Medical Terminology
  • Medical Coding (CPT, ICD-9, HCPCS and use of CCI Edits)
  • Fee schedule analysis, rates of contracting and credentialing process
  • Computer systems, billing and information of patient security
  • Accurate and quality data as well as patient demographic information
  • Vast knowledge regarding various insurance plans like PPO, Open Access, Managed Care, HMOs, Medicaid, Medicare, Capitated, Out of State Plans, Federal Employees Program, National etc.
  • Using Proper Medical Modifiers
  • HIPAA Compliance, Guidelines and Policies
  • OIG’s Recommendations for Compliance


Description of a Medical Claims Billing Manager

The best Medical Claims Billing Managers will have the following job responsibilities in their practice-

  • They are responsible for leading and directing the company’s billing and collection efforts. They should be analytical, educated and knowledgeable, as necessary.
  • He/she should direct all the functions of Medical Billing Department
  • He/she should assure all signed forms are on file.
  • He/she should submit daily electronic claims.
  • He/she should check the patient’s benefits and eligibility verification.
  • He/or she should maintain accurate patient’s demographic information and data on file.
  • He/she should settle charges and/or meeting forms with appointments.
  • He/she should perform internal audits.
  • He/she should maintain and update the Internal Medical Billing as necessary.
  • He/she should review and analyse fee schedules, contracting rates and the EOBs.
  • He/she should review and analyse any new patient’s registration, billing and collection productivity reports that includes detail of accounts by type, coverage and reasons for unbilled and aged reports.
  • He/she is primarily responsible for reviewing monthly reports, quarterly and yearly reports. is a company that offers its quality billing and collection services in various medical fields. They offer their dedicated services to serve different medical practitioners.