Medical Billing: What is it, Process & Career Options
Have you ever thought about what happens after you visit a doctor? After you get a prescription or a diagnosis, there is an important process that starts called medical billing.
This guide is for anyone new to healthcare, thinking about a job in billing, or just curious about how hospitals and clinics get paid. We will explain it in a simple and easy way, without using difficult words.
What is Medical Billing?
Medical billing is the process of creating and sending bills for healthcare services. When a patient visits a doctor, hospital, or clinic, the treatments and services are recorded. These records are then turned into a bill, which is sent to the patient’s health insurance company or directly to the patient. This process ensures that the healthcare provider gets paid for their work.
Medical billing also involves checking insurance coverage, following up on unpaid claims, and making sure all the information is correct. It plays a key role in helping hospitals and clinics manage their income and continue to provide care.
Medical Billing Process: Step by Step
Let’s walk through what happens step by step.
1. Patient Scheduling and Registration
It all starts when someone books an appointment. At check-in, the office collects basic info like your name, insurance provider, and medical history.
2. Insurance Check
The admin team verifies your insurance. They confirm what services are covered, if referrals are needed, and how much you’ll owe out of pocket.
3. Medical Coding
After the visit, the doctor documents your condition and treatment. A medical coder takes this and assigns standard codes like ICD-10, CPT, or HCPCS to describe the services.
This part is crucial — it’s what tells the insurance company what was done and why.
4. Charge Entry
The codes are matched with prices and entered into billing software. It’s like filling out a detailed invoice.
5. Claim Submission
The bill (claim) is sent to your insurance provider electronically. This is where accuracy really matters — even a small error can cause delays or denials.
6. Insurance Review
The insurance company reviews the claim. They may approve the full amount, partially pay it, deny it, or request more information.
7. Patient Billing
Once the insurance pays its share, the remaining balance is billed to the patient. This might include a co-pay, co-insurance, or deductible.
8. Payment Posting
When payments are received (from both insurer and patient), they’re recorded in the system.
9. Follow-Up and Appeals
If a claim is denied, billers investigate, make corrections, and resubmit it. Sometimes, appeals are filed for full or partial reimbursement.
Medical Billing vs. Medical Coding
People often confuse the two — and it’s easy to see why.
- Medical coders focus on translating diagnoses and procedures into standardized codes.
- Medical billers take those codes and submit claims to get the provider paid.
Think of coders as the translators, and billers as the financial coordinators.
Who Does Medical Billing?
Medical billing can be handled in-house at hospitals, clinics, or even by third-party billing companies. Billers work with doctors, coders, insurance reps, and sometimes directly with patients.
With the rise of remote work, many billers now work from home using cloud-based tools and EHR systems.
Skills You’ll Need to Be a Successful Medical Biller
This isn’t just a data-entry job. Good billers are:
- Detail-oriented
- Familiar with billing software like Kareo, AthenaHealth, or AdvancedMD
- Strong communicators
- Quick problem-solvers when claims hit a snag
- Up to date with healthcare laws and HIPAA compliance
How to Start a Career in Medical Billing
Thinking about jumping into this field? Here’s how to begin:
- Take a certified course — many are available online.
- Learn medical terminology and master systems like CPT and ICD-10.
- Get certified through AAPC or similar organizations.
- Gain real-world experience through internships or entry-level positions.
Once you’re trained, you can work for providers directly or as a freelance biller
Final Thoughts
Have you ever wondered what happens after you visit the doctor? After you get your prescription or diagnosis, there’s an important step called medical billing that takes place.
If you’re new to healthcare, interested in a billing career, or just curious about how hospitals and clinics get paid, this guide is for you. We’ll explain everything in a simple and easy way, with no confusing terms.
Want to learn more and start a career in this field? Check out our Medical Coding Course to get started
