Interview with Medical Billing Certified Professional, Jaclyn Ly

Programs and Schools

Jaclyn Ly of of South Riding, Virginia is a medical billing professional with nearly six years of professional experience and holds a Certified Professional Coder designation from the American Academy of Professional Coders. As an employee of Capture Billing & Consulting Inc., she does everything from taking patient calls to running reports for doctors each month. Career Colleges recently interviewed Ms. Ly to gain an understanding of her day-to-day duties and professional background.

Q. What made you want to become a medical biller?

A. At the time I had recently moved to Virginia and was looking for a new career. I heard that health care, especially the medical billing field, was growing and that people were going to be needed to fill positions so there would be lots of opportunity.

Q. What medical billing education did you receive before beginning your career?

A. I took a nine month medical billing course. At the end of the nine months of training, in order to graduate I did three months of externship at Capture Billing, a medical billing company that works with the school to help students learn in a real medical billing office. Capture Billing hired me after my externship.

Q. What is a typical workday like?

A. A typical workday consists of plenty of fast-paced work, which I love as there is never a dull moment. I enter charges for the patients that were seen each day, submit the claims to the insurance companies, then I make sure insurance companies pay the charges correctly and promptly and that the patients pay their account balances. I handle calls from patients and run monthly reports for the doctors.

Q. How can you move up and get promoted in medical billing?

A. Becoming certified in coding. There are several certifications that possible in this field and the more one knows, the faster can move up in medical billing. Certifications allow medical billing professionals to become more valuable to their employer with more credentials. They might start as a biller working on a team, then become team leader of the medical practices billing staff, then maybe go into management and be a billing manager. Some people have also gone on to become practice administrators in medical offices.

Q. How have you grown in your role from previous years?

A. I started with pediatrics, in both office and hospital billing. It is very easy to stick to one type of medical field in this business and only know that field, but now I have also become very seasoned in family practice. Knowing the insurance companies policies that go along with these types of practices [is important] as the policies are very different for each. I have learned to research the policies and billing rules from the insurance companies in order to help get the proper reimbursements from my practices. With the experience I have gained over the last 6 years I now know what needs to be done when talking to insurance representatives and writing appeals and reconsideration for denied and under-paid claims.

Q. What do you wish you knew starting out in your medical billing/coding career that you know now?

A. Where do I start? Definitely how hard it is to receive correct payment sometimes from insurance companies. In some cases, they do not make our jobs easy. I did not know insurance companies actually do not want medical billers follow up on unpaid claims or talk to insurance reps.

I also did not realize that proper coding can be different than proper billing. Turns out each payer can have their own rules [about] how they want things billed. Bill it wrong and your doctors do not get paid. Oh, and then there are modifiers that get appended to CPT codes that must be used. Medicare makes up some of their own modifiers and codes that are specific to only them. Medical billing is very complex and must be done right.

Q. What is your favorite part about your job?

A. I love having no down time. The work is never done. The day goes by fast and I am always learning new things.

Q. What is one thing you like least about this career?

A. I think that would have to be when the insurance companies give me a hard time about payments, adjustments, primary/secondary issues, and appeals. It gets frustrating playing their game. I know they just hope we give up, but I will not.

Q. What is the most challenging part of your job?

A. I think that would be changing from practice to practice and then to hospital and then from doctor to doctor. It's hard to jump around without issues. Also, many doctors' handwriting is terrible.

Q. What skills are most valuable for a medical billing and coding job?

A. Experience. Also, remembering how insurance companies like the charges submitted, as each one is different and learning that can help medical billers avoid many obstacles.

Q. What kind of advice would you give a new student going through a medical billing and coding program?

A. Read the CPT and ICD-9 books thoroughly and know medical terminology. Take advantage of any externship or internship programs that local billing companies or medical practices may provide. Those first three months externing at Capture Billing really helped me put what I had learned into practice. It was a bit different doing it live.

Please note: Unless explicitly stated otherwise, any job outlook predictions, career/educational advice, and salary information found on this page are based solely on the opinion of the interviewee and not that of or any other organization.