Background Knowledge Necessary for Starting a Home Medical Insurance Billing Business

Medical insurance billing, thanks to the existence of multifaceted and user friendly medical billing software and online billing interfaces has become a popular home business idea. People that do medical billing from home often get an initial education of some sort in medical billing and then set up shop so they can begin marketing their services to doctor practices, hospitals, clinics, and so on. They can be considered medical billing or medical insurance specialists that work in a freelance context. The following are some areas of skill and knowledge of which these home based medical insurance billing specialists need to have good command:


Insurance companies use universally accepted codes to process insurance claims and make assessments as to how much they should pay out. So a medical insurance billing specialist who works from home (or form an office for that matter) needs to be very familiar with these codes. Coding is a career in itself that is often handled by dedicated individuals called coders. The coding process, which involves looking at patient records and assigning codes to the various medical services that a doctor has performed, may or may not be part of the duties of a home based medical biller. Often the coding is done in office and the medical insurance billing specialist only works with claim submission and negotiating with insurance companies, doctors, and patients. However, a biller must be very familiar with the codes in order to do this kind of office work and negotiation.

Local Health Plans

Medical insurance billing specialists need to be familiar with local types of health insurance in the areas where they are doing businesses. Health insurance providers and the regulations that govern their activity often differ from state to state. So the biller has to know what these plans are and have a good thorough background in all the fine points of these plans. A good way to do this is to read all the literature on a locally used health plan.

Local Regulations

A medical insurance billing specialist also needs to know local laws and regulations that apply to the health insurance industry. This allows them both to avoid breaking any of these laws and to use the legislation that is in place to thee advantage of doctors and patients. For instance, if an insurance company tries to dispute their responsibility to pay out on a claim due to a legal loophole, the medical insurance billing specialist needs to know the law so that the matter can be settled – hopefully in favor of the doctor or patient. They may either suggest alternate legal approaches or attempt to prove that the insurance company’s interpretation of the legal parameters of the situation are incorrect.

Medical Billing Software

A home based medical insurance billing professional needs to have good command of some popular types of medical billing software. They will be using this software actively on a day to day basis to submit claims to insurance companies, correct errors, run analyses, and many other functions. This is basically the bedrock of a home based business. Unless someone is going to do everything by hand, telephone, fax machine, and regular mail, they will be relying heavily on the increasingly feature loaded and versatile software now available for medical insurance billing.

Just using this software on a day to day basis will be good instruction in itself. But before setting up shop to do medical billing, the biller needs to be able to use the software at a high degree of proficiency and to convince clients that they have not only industry knowledge but technical savvy. So the best approach is to learn the software system long before opening the doors of the business.

Customer Service

In addition to all the industry specific knowledge that is required, a home based medical insurance billing specialist needs to be able to provide good customer service. That is, they must deal with doctors, insurance professionals, and patients in a friendly and professional manner. They need to be able to answer questions any of these parties may have about the insurance claims process and to be accessible enough that customers feel they can reach the specialist when necessary.

Medical insurance billing can be a lucrative and rewarding home business idea to pursue. But it does take study and skill building before an individual can get into it and hope to get clients. The main perception that the biller needs to foster is that of a competent and friendly professional that is able to effectively resolve claims.