Pros and Cons of Being a Medicaid Billing Specialist
With around 29 million adults receiving Medicaid benefits in 2012, it is no wonder many health care providers need billing specialists with expertise in Medicaid billing. Becoming a Medicaid billing specialist can be a sound career choice, but you should consider all the pros and cons before making a decision.
| Pros of a Medicaid Billing Specialist Career |
|---|
| High job-growth field (18% for all billing clerks)* |
| Minimal education requirements (high school diploma and possibly a certificate)* |
| Clean, temperature controlled working conditions* |
| Diversity of workplaces (hospitals, physicians' and dentists' offices, government health departments)* |
| Cons of a Medicaid Billing Specialist Career |
|---|
| Relatively low salary (About $30,000 in May 2014)* |
| Spend all day sitting at a computer* |
| Must keep up with changes in regulations, coding** |
| May work nights, weekends* |
Sources: *U.S. Bureau of Labor Statistics, **American Academy of Professional Coders
Career Information
Job Description
Medical billing specialists create statements detailing the health care services rendered and the charges incurred. They send these bills to insurance companies or to the patients. Billing specialists use standardized codes for various diseases and medical procedures. While billing specialty and coding jobs are not necessarily the same, their duties overlap and often are combined into one position.
The Centers for Medicare & Medicaid Services (CMS), part of the U.S. Department of Health and Human Services, supervises Medicaid billing and coding. Physicians with many patients covered under Medicaid, as well as government health departments, require billing specialists who are familiar with Medicaid and its regulations. Job postings show that billing specialists must be familiar with many types of insurance, not just Medicaid.
In addition to preparing statements, medical billing specialists may speak with insurance companies and with patients. They may perform some clerical and bookkeeping duties, such as posting payments, and handle debt collection in some health care facilities.
Career Prospects
The U.S. Bureau of Labor Statistics (BLS) predicted employment in most health care-related professions, including billing, would grow faster than average in 2012-2022 due to an aging population that requires more health care services. The BLS expected employment for all types of medical assistants, including administrative assistants such as billing clerks, to rise by 29% over that decade and expected employment for financial clerks, including those in medical billing, to increase by 11% during that period.
In January 2014, the Affordable Care Act will open up Medicaid to more low-income adults, possibly creating a demand for billing specialists who are well versed in Medicaid.
Salary Info
The BLS reported the median annual salary for all types of medical assistants, including billing and coding specialists, as approximately $30,000 in 2014. Salary.com reported the median salary for a medical billing clerk as about $35,000 in 2015, with half of the people in the profession earning about $32,000-$38,000.
What Are the Requirements?
Many medical billing specialists begin work after earning a high school diploma or a GED certificate and completing several months of on-the-job training. The BLS says anyone considering this career should take high school courses in biology, anatomy and chemistry. The BLS notes that many employers prefer to hire someone with a certificate or a diploma in medical billing.
Useful Skills
According to job postings, computer proficiency is necessary, as is the ability to communicate in writing and verbally. A successful billing specialist must be organized and pay attention to details.
Job Postings from Real Employers
Job postings show that physicians in private practice, as well as public health departments, need billing specialists who are knowledgeable about Medicaid's billing procedures. The specialists also must be informed about Medicare, Tri-Care and HMOs and PPOs. Here is a sampling of what real employers were looking for in April 2012:
- A public health department in Georgia needed someone with at least seven years of Medicare and Medicaid billing experience to serve as the agency's Medicare/Medicaid billing expert. An associate degree or higher was preferred. The person hired would resolve claims denials, troubleshoot problems and review payment disputes.
- In Indiana, a temporary firm needed a billing specialist with at least two years of experience in Medicaid, Workers' Compensation, Medicare and private insurance to process statements. Collections on overdue bills would also be part of the duties.
- A pediatrician in Georgia was looking for a specialist knowledgeable in Medicaid and various types of private insurance. This person must be proficient in several types of medical coding. Collections would be included in the job, and the doctor said good collectors could earn a bonus incentive.
- In Utah, a temporary placement service needed a medical billing specialist with experience in Medicaid/Medicare and with all major insurance companies. The ad said the pay was dependent on experience.
How to Stand Out
Earn a Certificate or Diploma
Many medical billing specialists start work with a high school diploma or GED certificate, but employers often prefer someone with a certificate or a diploma in medical billing from a community college, technical school or professional association. During this training, you will study insurance coding, medical terminology and billing for Medicare/Medicaid.
Professional Certifications
Some employers want billers who hold credentials from professional associations. The Medical Association of Billers (MAB) offers the Certified Billing Specialist designation to billers who have completed their training courses and passed a proficiency exam. Other organizations, such as the American Academy of Professional Coders (AAPC) and the American Health Information Management Association (AHIMA), offer certifications for coding. Some credentials require that you have formal training, while others accept experience.
Other Career Paths
Medical Transcriptionist
If you want to work in the health care industry, but don't like the thought of negotiating with patients and insurance companies, perhaps you would enjoy a career as a medical transcriptionist, listening to recordings from physicians and other professionals and typing them into the patient's health record. You'll need excellent spelling and grammatical skills as well as solid keyboarding ability. Transcriptionists must complete a 1- or 2-year postsecondary training program. The BLS expected employment of transcriptionists to grow by about six percent from 2010-2020, more slowly than average. The median annual salary for a medical transcriptionist was about $33,000 in May 2011, according to the BLS.
Insurance Claims Examiner
If you'd like to make a bigger salary, but stay in the field of insurance and health claims, perhaps you should check out a career as an insurance claims examiner. Most work for health insurance companies, looking at claims filed to see if the costs are in line with the diagnosis and treatment. You need a high school diploma to get started in the field, although some college might help you advance. The BLS forecasted that employment for claims examiners would grow by three percent from 2010-2020, slower than average for all occupations. The median salary for claims examiners, adjusters and investigators was approximately $59,000 in May 2011, the BLS reported.
