Module 1, Topic 1
In Progress

Day 4: Role of a Biller/Collector

Petria September 3, 2020

Role of a Biller/Collector

Understanding Medical Terminology and Billing Codes

A home health care biller must be able to understand medical terminology and billing codes and use them correctly on claim forms.


Biller’s Duties

  • Transmits RAPs
  • Transmits Finals
  • Transmits/Processes Claims
  • Pre-billing Audits
  • Copies  Notes, etc.
  • Medical Records
  • Giving them input and collecting any new files and information for billing
  • Filling out insurance forms & ensuring they are properly coded before claims submission
  • Processing files

Claims should go out either daily, every other day,  weekly, or bi-weekly depending on the agency’s size and claim volume.


Ideal billing staff qualities

  • Self motivated/self starter/ self directed
  • Problem solver
  • Good communicator
  • Accountable
  • Team player
  • Detail oriented
  • Organized
  • Conscientious of policies & risk
  • Dot I’s & Crosses T’s
  • Committed
  • Stable/reliable/attendant/integrity
  • Unafraid of technology
  • Quick learner
  • Willing & able to do what needs done
  • Unafraid to try new things
  • Unafraid of constructive criticism
  • Flexible & adaptable
  • Don’t like change



  • Hi C’s
  • Personality Types
  • Perfectionist Pattern
  • Objective Thinker Pattern

Other tests that can be used:

  • Career Hunter
  • Sokanu Career Test
  • Myers-Briggs Type Indicator Instrument
  • Red Bull Wingfinder
  • John Holland’s Self Directed Search


What biller and collectors need to succeed

  • One on One Training
  • Periodic billing operations review
  • Have a cycle
    • Establish daily/weekly/monthly routines
    • Need measurable outcomes
    • Loves healthy competition


Typical billing problems

  • Poor/Unorganized billing tracking
  • Pre-billing audits
  • Poor supervision/management oversight
  • Limited or no billing training
  • Poor communication between billing & clinical staff
  • Inadequate time spent on follow-up (20%/80% rule)
  • Poorly implemented billing routines
  • Lack of accountability
  • Inadequate knowledge & functionality of software
  • Analysis Paralysis
  • Not checking receipt of claims with Medicare


What does a Successful Biller Look?

  • Timely claims submission
  • Great communicator
  • Gets Training Constantly
  • Vast FISS/DDE knowledge
  • Established processes
  • Has a routine
  • 98% first pass rate


Collector’s Duties

  • Works Medicare T, D, R, & I status   claims
  • Tracks Medicare ADRs
  • Works accounts receivable reports
  • Resolve Medicare Secondary Payer issues
  • Check on the status of previously submitted claims & resubmit new claims



Types of Software Billers May Use

  • Billing
  • EMR
  • Clearinghouse
  • DDE


Using Specialized Software

  • Purchase Medical billing software programs to create and process bills.
  • More efficient
  • Less tedious and time consuming
  • Be prepared to learn not only the billing component of the software  but also all the reports to help you be successful