Description
Compile, compute, and record medical billing and insurance claim data, ensuring accurate charges, codes, and patient account records. Prepare and submit claims and patient invoices for services rendered, post payments, and resolve denials in compliance with payer rules and HIPAA.
- • Process refunds and approved write-offs.
- • Verify patient demographics, insurance eligibility, and coverage before billing.
- • Review documentation and charge tickets to confirm correct CPT/HCPCS and ICD-10 codes.
- • Enter charges and modifiers in the practice management/EHR system.
- • Prepare and submit electronic and paper claims (CMS-1500/UB-04).
- • Scrub claims for edits and missing data; correct and resubmit.
- • Post payments, adjustments, and denials from EOBs/ERAs.
- • Reconcile daily charges, deposits, and postings.
- • Generate and send itemized patient statements and invoices.
- • Contact patients to obtain information, explain balances, or set payment plans.
- • Contact payers to verify benefits, obtain authorizations, or resolve issues.
- • Research and resolve billing discrepancies, credit balances, and unapplied cash.
- • Maintain organized records of claims, remittances, and supporting documents.
- • Follow up on unpaid or denied claims within timely filing limits.
- • Analyze remittance and denial codes to determine corrective actions.
- • Update payer fee schedules, rules, and billing guidelines.
- • Calculate patient responsibility for copays, deductibles, and coinsurance.
- • Prepare credit memos, receipts, and account adjustments.
- • Answer billing and coverage inquiries by phone or email.
- • Review and clear clearinghouse rejections and transmission errors.
- • Ensure HIPAA and privacy/security compliance when handling PHI.
- • Assist with month-end reports on charges, collections, and A/R.
- • Coordinate with coding, clinical, and front-desk staff to correct errors.
- • Process returned mail and update patient contact information.
- • Monitor billing software and printers; troubleshoot minor issues and escalate as needed.
- • Scan and attach referrals, authorizations, and medical records to claims.
- • Maintain inventory of billing forms and office supplies.
- • Participate in audits and quality checks of billing records.
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Tasks & skills:
O*NET occupational data (work activities, skills, knowledge).
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This site includes information from O*NET by the U.S. Department of Labor, Employment and Training Administration (USDOL/ETA), used under the CC BY 4.0 license. Career Clutch has modified some of this information for student readability. USDOL/ETA has not approved, endorsed, or tested these modifications. O*NET® is a trademark of USDOL/ETA.
Last reviewed: Jan 2026
