Running head: Medical Biller Research Paper 1 Medical Biller Research Paper 2Medical Biller Research PaperLindsay Williams Liberty University 2/13/2020Medical Biller Research Paper The medical biller are healthcare professionals who translate healthcare service to medical claims. The medical billers assess the healthcare services given to a patient and submit claims to the insurance companies and healthcare players such as Medicaid and Medicare. This position is very essential for the financial cycles of the health care providers form a single provider operation to large healthcare facilities. Thus, to be a medical biller, one needs to have basic knowledge in financial analysis and health operation. This knowledge should be accompanied by high level of analysis and combining concepts. In this case, the paper will analyze five topics that are essential for research billers. These topics include; the experience and Qualifications for Insurance Claim Processors, job Functions of a Medical Insurance Processor. Workers compensation, submitting claim electronically and common mistakes resulting claim denials will be also analyzed. The Insurance Claim Processor or the claim examiners are healthcare insurance employees who assess the medical claim to decide whether an insurance company will pay the claims. The claim examiner job has no specific educational qualification. Though many organizations require one to have a minimum of high school college diploma depending on the organization working policy. Most of the organizations offer in job training, though they recommend the applicant to have knowledge in the related field. For this course, various vocational training schools offers various courses related to this field. (Alyson, 2020). In this role, its highly recommend for candidate to take certified medical reimbursement specialists’ exam. Thus, since there no experience required during hiring of Insurance Claim processors, organizations should provide orientation and on-job training. The Insurance Claim Processor should have good communication skills. The claim examiners should be able to communicate effectively both in writing and verbally. These skills enable them to understand the claim reports, for analysis. The claim examiners should able to communicate feedback clearly to the victim both in writing and verbally. The claim examiners should have good customer service skills such as patience, self-control, critical and logical thinking to help the associate well with clients. Medical Insurance Processor analyses the validity of medical claims, in the insurance companies to determine whether they are viable for payment. The Medical claims processor managers all the insurance claims from the doctors’ offices. Theprimary role of the Medical Insurance Process evaluates the claims presented in the insurance companies. They have number of responsibilities that revolve ar.

1. Running head: Medical Biller Research Paper
1
Medical Biller Research Paper
2Medical Biller Research PaperLindsay Williams
Liberty University
2/13/2020Medical Biller Research Paper
The medical biller are healthcare professionals who translate
healthcare service to medical claims. The medical billers assess
the healthcare services given to a patient and submit claims to
the insurance companies and healthcare players such as
Medicaid and Medicare. This position is very essential for the
financial cycles of the health care providers form a single
provider operation to large healthcare facilities. Thus, to be a
medical biller, one needs to have basic knowledge in financial
analysis and health operation. This knowledge should be
accompanied by high level of analysis and combining concepts.
In this case, the paper will analyze five topics that are essential
for research billers. These topics include; the experience and
Qualifications for Insurance Claim Processors, job Functions of
a Medical Insurance Processor. Workers compensation,
submitting claim electronically and common mistakes resulting
claim denials will be also analyzed.
The Insurance Claim Processor or the claim examiners are
healthcare insurance employees who assess the medical claim to
decide whether an insurance company will pay the claims. The
claim examiner job has no specific educational qualification.
Though many organizations require one to have a minimum of
high school college diploma depending on the organization
working policy. Most of the organizations offer in job training,
though they recommend the applicant to have knowledge in the
related field. For this course, various vocational training
schools offers various courses related to this field. (Alyson,

2. 2020). In this role, its highly recommend for candidate to take
certified medical reimbursement specialists’ exam. Thus, since
there no experience required during hiring of Insurance Claim
processors, organizations should provide orientation and on-job
training. The Insurance Claim Processor should have good
communication skills. The claim examiners should be able to
communicate effectively both in writing and verbally. These
skills enable them to understand the claim reports, for analysis.
The claim examiners should able to communicate feedback
clearly to the victim both in writing and verbally. The claim
examiners should have good customer service skills such as
patience, self-control, critical and logical thinking to help the
associate well with clients.
Medical Insurance Processor analyses the validity of medical
claims, in the insurance companies to determine whether they
are viable for payment. The Medical claims processor managers
all the insurance claims from the doctors’ offices. Theprimary
role of the Medical Insurance Process evaluates the claims
presented in the insurance companies. They have number of
responsibilities that revolve around the verifying whether
company should pay the claim or clients losses. The first role is
helping the insurer to review the insurance policy agreement to
determine the kind of cover if any the claim or loss can be
accorded. The claim processor provides customer services to
clients who need guidance on how to file claim or any other
help. After verifying the claim and determine its validity, then
the claim processor facilitate the forms and paperwork to
facilitate the payment. If some of the information is missing,
then the claim processors contact the client to provide the
additional information. In some cases, the claim processor
calculates the payment and pay the client, this is usually case
for standard of claim. But for the complicated claims, then they
forward the claim to management for investigation. The Medical
claim processor has other administrative role they play when
they are not verifying or paying the claims. They claim

3. processor process new insurance and modify the existing
policies to ensure they reflect new policies and coverage
protocol. Also, they apply insurance rating systems to policies
and claims.
The primary role of the organization is to provide security to its
worker. The effort to ensure worker works in secure
environment doesn’t guarantee workers safety, accident to
happen. Organization should have a sound workers
compensation policy. The compensations are aimed to facilitate
victims’ treatment and pay bills when they cannot report work.
In case a worker in covered organization becomes sick get
injured due to working environment of incident occur in the
organization, the one may qualify for compensation claim
(Moore & Viscusi, 2014). Thus, employees should understand
workers compensation policy to ensure they receive best
compensation package. From the legal perspective all
organizations should have sound workers compensation and
failure to adhere to this regulation, organization will face legal
action. Workers compensation is very essential part of business
benefits package. The work compensation provides security in
two fronts. First, the workers compensation protects business
legal complication and lawsuits after accident happen. The
worker compensation helps to facilitate workers receive
healthcare service after accident and also help them to receive
some portion of their income until they return back to work.
The workers compensation doesn’t consider whose fault was,
thus consider all incident as accident.
The advancement of technology has changed many operations in
the organizations, from paperwork to electronic operation.
Submitting claim electronically is one the effect of technology
advancement. Electronic claim submission is paperless victims’
claims that are done through computer software to the health
insurer (Wargin, Dahle& Weiss 2012). In this topic there are
various concepts that medical biller should understand to
improve knowledge.
There exist many options that the electronic service providers

4. provide to conduct electronic claim submission, but mainly
there are two broad approaches of electronic claim submission –
full-service and electronic service electronic claim submission.
Under this approach, the claim is filed by service provider on
behave the healthcare provider. The psychologist or the third
party only send the basic detail of patient and service to the
bailing service. The bailing services develop claims and submit
them direct to the insurer. The self-service electronic claims are
generated and filed by psychologist direct to the third party or
the health service claims clearing websites. The submission is
done through the software provided by the player. Filling
healthcare claims electronically offers many benefits to the
organization and the patients. Help to reduce disruption of the
cash flows; this approach allows quick assessment of results
thus, allow faster payment (Wargin.at el, 2012). Benefits are,
cut down paperwork and increase the level of accuracy and save
time and overhead cost.
In some case, medical claims are denied, in some case, it’s not a
major error of flaw of the players but small omissions of
mistake that occur during claim submission. Thus, in case of
claim denial, it’s appropriate to assess the submission instead of
blaming the player. There are some common mistakes that result
to denial of claims (Feinman, 2012). Some of the mistake
includes the following. The failure of the patient to adhere to
health insurer claim policy may result to the claim being
illegible and thus, it will be denied. During submitting the
claim, it’s essential to check whether required procedure and
format is adhering to according to insurer policy.Printed
materials are illegible and messy and thus make scanning
problematic.
Staffs miss to record some of the encounter in the bailing
document; this may affect to claim operations. Insurers are keen
to detail and thus, they will quickly notice omission and count
such omission as enough ground to reject claim. The insurer
may also denial claim due to lack of specification. The late
denial is common form of medical claim denial. Player operates

5. in their deadline and schedule; thus, this can make the
healthcare provider miss the insurer filing deadline. The insurer
should keep communicating their time schedule to allow
healthcare provider to comply with this deadline.
The medical biller should have this information in mind to be
able to complete their task effectively. The medical biller
interacts with this situation on regular basis if not daily and
thus they should be conversant with it. Medical claim involves
various processes which should be done accurately to meet the
insurer policy as well as the standard placed. With increased
changes especially in information technology, the medical biller
should learn its effect on claim submission.
References
Alyson, J. (2020) Claims Processor: Jobs and Responsibilities.
Retrieved on February 11, 2020, from
https://work.chron.com/claims-processor-jobs-responsibilities-
14439.html
Feinman, J. M. (2015). The Law of Insurance Claim Practices:
Beyond Bad Faith. Tort Trial & Insurance Practice Law Journal,
693-740.
Moore, M. J., & Viscusi, W. K. (2016). Compensation
mechanisms for job risks: wages, Workers' Compensation, and
product liability. Princeton University Press.
Wargin, J. M., Dahle, D. R., & Weiss, J. G. (2015). U.S. Patent
No. 8,401,896. Washington, DC: U.S. Patent and Trademark
Office.
Research Paper Part 3-Final Rubric
Criteria
Levels of Achievement
Content 70%
Advanced
Proficient
Developing

6. Not present
Points Earned
Key Components
100 to 90 points
Report has a professional tone and addresses 5 topics in a
logical manner. Professional tone includes 3rd person and
proper citations.
89 to 70 points
Report has mostly a professional tone and addresses 5 topics in
a logical manner, but with errors. Professional tone includes 3rd
person and proper citations.
69 to 1 points
Report lacks a professional tone but addresses 3–5 topics in a
logical manner.
0 points
Report does not address topics in a logical manner.
100
Sources
40 to 36 points
Report includes 4–5 academic references published within the
last 5 years. Academic references include textbooks, peer-
reviewed journals, .edu websites, and .gov websites
35 to 28 points
Report includes 3-4 academic references published within the
last 5 years. Academic references include textbooks, peer-
reviewed journals, .edu websites, and .gov websites.
27 to 1 points

7. Report includes academic references not published within the
last 5 years. Academic references include textbooks, peer-
reviewed journals, .edu websites, and .gov websites.
0 points
Report includes sources that are not acceptable for the
assignment such as .com, .net, .org, blogs, or sources with no
dates.
40
Structure 30%
Advanced
Proficient
Developing
Not present
Points Earned
Mechanics and APA
30 to 27 points
Paper consists of well-constructed paragraphs. Paper includes
an APA title page, reference page, and in text citations.
26 to 21 points
Paper consists of well-constructed paragraphs. Paper includes
an APA title page, reference page, and in text citations—but
with errors.
20 to 1 points
Paper is somewhat disorganized or paragraphs are not well
constructed. Paper includes title page, reference page, and in
text citations—but with errors.
0 points

8. Information is disorganized or not in paragraph format or a title
page, reference page, and/or in text citations are not included.
30
Word count
20 to 18 points
Paper was submitted to Safe Assign and is at least 1500 words
of content.
17 to 14 points
Paper was submitted to Safe Assign and is between 1200-1499
words of content.
13 to 1 points
Paper was submitted to Safe Assign between 800-1199 words of
content.
0 points
Thread is less than 800 words of content, or paper was not
submitted to Safe Assign.
20
Spelling and grammar
10 to 9 points
Proper spelling and grammar are used. Paper is free of
typographical errors.
8 to 7 points
Between 1-2 spelling or grammar errors present. Paper is free of
typographical errors.

9. 6 to 1 points
Between 3-4 spelling or grammar errors present, or paper has
typographical errors.
0 points
More than 4 spelling or grammar errors present, or multiple
typographical errors.
10
Total Points
/200
Instructor’s Comments: