Chapter 2 -Lesson 5, 6, 7,

Your Career Opportunity as a Home Medical Claims Specialist

John is the sole owner and operator of John's Claims Service, a medical claims processing business. He works from his home in Milwaukee, a large metropolitan city. John handles the billing for several doctors in the Milwaukee area. Unlike most independent billing services who work with several medical providers, John’s medical claims service bills for only two medical practices, Graybeard Clinic and Stone Ridge Clinic. In addition to processing claims everyday, John must pick up bills every other day from different clients.

John then converts billing information and paper billing statements to the billing software, to the HCFA 1500 paper form, or to other paper forms for each claim. At the end of the day, John either mails each paper claim to the appropriate insurance carrier or electronically submits each claim to a clearinghouse. Since John is paid on a per claim basis, he realizes the importance of keeping accurate records and maintains a file for all documentation in either an electronic file or a paper file.

At the end of each month, John bills the medical office or doctor based upon the number of claims filed. The difference between John’s independent billing service and that of the billing specialist who works at the hospital or office is that John may have two, three or more groups of doctors as clients. John must keep track of which claims came from which client.

Now that you understand the routine of a work-at-home claims specialist, we can show you John’s method of running his at-home business office, his record-keeping system, and how he stays current with new trends in his field.

Starting an at Home Office

When you work at home, it is imperative that you remain efficient and focused. When working at home, set aside a place where there are no distractions, a place which enables you to concentrate on doing business. If you live alone, you can set up an office virtually anywhere in your home or apartment; however, if you do not live alone, you must find an area that is removed from all work interference.

When working with medical providers, a high degree of professionalism must be maintained. Although you will find that most doctors are easy to work with, some medical providers have a unique way of doing business and may rely heavily on their own office procedures. It is your job as a medical claims processor to accommodate them and, most importantly, to assist them in receiving payment as soon as possible for the services they have performed for their patients.

Confidentiality

Confidentiality cannot be emphasized enough. When working at home, you must understand that all patient information and medical records have been entrusted to you, and it is your responsibility to treat this material with absolute and uncompromised confidentiality. This information should be locked up and stored in areas inaccessible to visitors, children or pets.

Continuing Education

In the rapidly changing insurance world, many insurance carriers often change the format and billing procedure when accepting claims. These changes can occur annually or semi-annually. It is your responsibility to stay educated regarding such changes. Electroniclaim will provide you with updates via e-mail as soon as our network managers acquire the updated information. We transmit to you updates regarding the medical industry every two to four weeks in order to keep you informed.

Professional Societies

As a medical claims and billing specialist, you may elect to join a professional organization, such as the National Association of Claims Assistance Professionals ("NACAP"). Doctors may also be members of organizations that are concerned with economic well-being for their members. These organizations are called colleges, and membership in them is voluntary. A doctor who joins a college is called a fellow of that college. The abbreviation F.A.C.O.G., appearing after a doctor’s degree, stands for Fellow, American College of Obstetrics and Gynecology.

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