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How to Build a Successful Medical Billing/RCM Team

When running a private practice, most of your time centers around patient care. But at the end of the day, you still need to get paid. And that requires some kind of medical billing team. 

While some practices outsource their billing, you may determine that keeping your medical billing team in-house is the best option for your business. If that’s the case, you’ll want to ensure you’re building the best possible team — after all, they manage the revenue cycle process that will keep your business running.

Not sure where to begin with hiring? We’ve got you covered. Let’s dive into some essential skills your medical billing team will need to be successful.

Steps to Take Before Building Your Medical Billing Team

Before you start searching for billing/RCM professionals, you need to consider a few crucial questions.

What Are the Financial Responsibilities for an In-House Medical Billing Team?

While hiring an in-house team may be the right fit for your practice, keep in mind that it will also come with financial and people management responsibilities. You’ll need to cover salaries and benefits. You’ll also need to manage, train and supervise the team — or hire someone to do this for you. And don’t forget about the billing/RCM software your team will have to use, which will come with an expense.

What Are My Competitors and Colleagues Doing?

Consider what other practices in your community or specialty are doing for medical billing. If they have an in-house team, how do they structure it? Are the employees remote, in-office or hybrid? What kind of benefits do they offer? 

Make sure your salaries, benefits and remote work offerings are equitable to what your colleagues and competition provide. Otherwise, getting the right people for your billing/RCM team may be difficult. 

What Are the Major Hurdles for Hiring a Skilled Billing Team?

Hiring the right specialists for a medical billing team may not be easy. It’s important to gauge expectations and understand some key challenges you could face, including:

  • You may not find many medical billing specialists who are skilled in your specialty. Depending on your niche, the candidate pool could be small. If you’re struggling to find people with the right experience, consider looking for candidates with related experience that you could easily train. Or, reconsider the possibility of outsourcing some of your billing.
  • There may be a big learning curve for your billing/RCM software. Depending on your billing/RCM software, your team may need some time to learn and adapt to the platform. Having a more user-friendly and straightforward platform can help shorten this learning curve.
  • You’ll need a plan for cross-training and staff turnover. If a member of your billing team leaves, will your revenue cycle suffer? A process for back-ups and cross-training will help you avoid payment disruptions. 

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What Makes a Good Medical Billing Specialist?

Before you craft a job description or sift through resumes, make sure you know the critical skills of a good medical billing specialist. Hiring someone with these abilities will ensure the success of your medical billing team and, ultimately, your revenue cycle. 

A skilled medical billing specialist should:

Understand the Insurance Verification and Upfront Collection Process

Insurance eligibility is one of the first and most important steps of healthcare revenue cycle management (RCM). If a billing specialist doesn’t understand this critical RCM step, your practice could face mountains of claim denials and rejections, which translates to lost revenue. 

Knowing how to optimize upfront patient collections is a critical skill at this stage, too, as it’s one of the most effective ways to increase your practice’s cash flow.

Know How to Create and Submit Accurate Claims

Medical billing specialists need to understand the claim submission process and timely filing deadlines, which can vary across payers. They also need an eye for detail, with the ability to spot claim errors or irregularities and make corrections before submitting the claim. A billing specialist without these skills could cost your practice thousands of dollars in lost claims filed late or incorrectly.

Closely Monitor Claim Status Progress

Once they submit the claim, will your medical billing specialist know how to track that claim throughout the RCM process? These individuals should be able to monitor claims for multiple specialties, payers and locations, knowing what stage the claim is at and how close your practice is to reimbursement.

Know How to Resolve Billing Discrepancies

Does the medical billing specialist know how to handle claim rejections and denials? Do they have experience working with clinicians and payers on reconsiderations? If not, you could lose out on revenue from un-reimbursed claims or write-offs.

Understand the Payment Posting Process

Once a payer reimburses your practice for a claim, will the medical billing specialist know how to post that payment and electronic or paper remittance advice (ERA or RA)? This step is critical for understanding your practice’s bottom line and the cash flow you have coming into your business.

Track Upcoming Payments and Payer Trends (Billing Manager or Director)

If you’re planning to hire a billing manager or director, keep in mind that this individual should have experience tracking upcoming payer reimbursements and payer trends. This knowledge will allow you to accurately predict revenue for your practice so you can grow the business effectively.

Effectively Manage Patient Billing

A skilled medical billing specialist should have a solid grasp on the claim submission and payer reimbursement process. They should also know how to manage patient responsibility, including creating and sending patient invoices. Ideally, they should also have experience managing these payments and their deadlines, knowing when and how to follow up with patients who haven’t paid their bills.

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5 Essential Tips for Building a Successful Medical Billing/RCM Team

Now that you understand the critical skills of a medical billing specialist, let’s put the pieces together and build the best medical billing team possible. Here are the essential best practices you should follow:

1. Look for Detail-Oriented, Analytical Individuals

Your medical billing team should include specialists who know how to analyze and process claims regardless of complexity. What’s more, they should have the eye to spot mistakes and the knowledge to make corrections if needed. 

It’s also crucial your team understands how to analyze trends across claims and reimbursements. When looking at your billing/RCM reports, can your team find a common thread across a claim type, payer, provider or location? Identifying these trends can help your business find opportunities to improve the claim filing process and grow your revenue.  

2. Find People with Experience in Your Specialty

Every specialty has different coding rules and quirks. Ideally, your medical billing specialists should have experience coding and submitting claims in your specialty so they can spot mistakes and make corrections. A cleaner claim process means faster and more complete payment. 

If you’re struggling with finding someone with experience in your specialty, consider hiring someone with transferable skills. For example, if you run a mental health or therapy practice, you’ll want to ensure your billers know evaluation and management (E&M) codes. On the flip side, your private primary care practice may not want to hire someone with only hospital billing experience, where most of the codes are facility-based (something your private primary care practice likely won’t need to bill).

3. Choose the Right Medical Billing/RCM Software

If you want a successful medical billing team, hiring the right people is critical — but it’s only part of the equation. You’ll also want to make sure you have the best billing/RCM software for your team. A reliable, customizable and user-friendly tool will help your team run efficiently. 

Before purchasing the software, consider these important questions:

  • What is the learning curve for the software? The longer it takes for your team to learn the platform, the longer it will take to get your billing and RCM on track. 
  • Will I be able to customize certain billing and insurance workflows for my specialty or practice? Otherwise, your team may spend lots of time on manual, repetitive tasks, which can strain your business. 
  • Does the platform have claim review warnings? This feature will help your team easily catch and correct errors before affecting our bottom line.  
  • Can I easily access financial information and reports? You should be able to quickly analyze RCM metrics and understand your business’s financial health without digging into convoluted spreadsheets.

4. Establish Clear Processes and Team Training

Documenting your medical billing processes will help avoid any kind of revenue gaps if employees are sick or leave the practice. Cross-training team members on the different billing/RCM tasks will also ensure you always have a smooth billing process.

It’s also crucial to document and train your team on payer guidelines, which can frequently change. Knowing the intricacies of each payer’s billing process will help your practice avoid costly claim rejections or denials.

5. Maintain a Culture of Communication

Good communication is at the core of any well-functioning business, and a private medical practice is no different. 

While each billing team member may play a different role in the RCM process, they should have the ability to collaborate with their team colleagues. For example, suppose one of your accounts receivable (A/R) specialists notices repeat rejections on certain claims. In that case, they should be able to communicate and work with a front-end billing specialist to resolve the issue and prevent future rejections.

Effective communication ultimately leads to improved processes and procedures, which saves time, reduces administrative costs and improves your cash flow.

Help Your Medical Billing Team — and Practice — Succeed

As a private medical practice, your ultimate goal is to help individuals live happier and healthier lives. But the reality is that you need money to succeed at that goal, which means you need a highly skilled medical billing team. Following these best practices can ensure you’re hiring the right people to help your business grow and thrive.

Ultimately, having the right billing team is only one half of the RCM puzzle. Employing the right RCM technology is the other. With Gentem’s industry-leading software, you’ll get access to AI-powered claim management, real-time financial dashboards and automated insurance billing workflows. Plus, our in-house RCM experts help optimize your reimbursement process to ensure you’re getting every penny you deserve. 

Ready to hear more about Gentem’s RCM solution? Sign up for a customized demo with our team today.

WATCH: Mastering Front-End vs. Back-End RCM

Join Gentem RCM expert Jenn Vaughn for a deep dive into the differences between front-end and back-end RCM. Get critical best practices and tips for increasing your practice’s reimbursements and revenue.

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5 Must-Know Metrics To Build A Thriving Medical Practice

With this free guide, you’ll learn the key metrics that inform your practice’s financial performance and how best to optimize them to support practice growth.

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