There’s no doubt about it: health insurance and medical billing can be confusing processes for ordinary people. That being said, the goal of medical billers is to protect consumers and ensure that health practitioners are treated fairly. There are many ways in which the process can sometimes trip up consumers, so here’s a quick guide which explains how it works.

It Starts With the Medical Biller

Medical billers are the ones who start the billing process. Given the high levels of technical knowledge and complicated information that flows between an insurance company and a healthcare practitioner, it’s important to understand that medical billers are experts in this field. In order to create an accurate financial record, they work directly with healthcare professionals to read a patient’s records and medical history, determine what to submit to a health insurance company, determine overall costs, investigate denied claims and ensure the protection of the patient’s private medical data.

Negotiating With Health Insurance

Medical billers work with healthcare practitioners and insurance companies on a regular basis, often handling these relationships for a wide range of professionals. As such, they will often be involved in the negotiating of healthcare bills. In this sense, medical billers can act as powerful and important middlemen who work to make sure that healthcare providers are paid fairly and that insurance companies cover much-needed treatments. Because of their expertise, they will often have a better understanding of the healthcare process then any in-house staff. They also have ample experience when it comes to managing negotiations for health care offices.

Medical Coding to Ensure Quality

Medical coding is more than just writing down what procedures happen on a piece of paper. Indeed, it’s such a complicated and technical specialty that it actually has its own certification. Medical coding is a highly technical process which involves noting a diagnosis, treatment, procedures and time that a medical staff spends with a patient. These billing codes then translate directly to charges and credits which appear on a patient’s medical history and billing information. This information, in turn, gets turned directly over to an insurance company for reimbursement.


Though medical billing can appear complicated from the outside, it’s important to remember that medical billers are trained professionals who seek to make the medical billing process as easy as possible. A good medical billing firm will be clear, transparent and assist all parties involved in completing a medical billing claim as quickly and fairly as possible. Toggle screen reader support


Check out our other content here