What is a Medical Biller & Coder? What Do They Do?
Medical billing and coding professionals are important members of the healthcare field. The Bureau of Labor Statistics (BLS) puts this profession within the medical secretary category and the entire field is expected to grow by 22% between 2016 and 2026. One big reason for this increase is the growth of the aging population in the U.S. because this group of people will increasingly need healthcare services. However, there has also recently been a shift to move health records into electronic storage and management; this has naturally increased the number of workers needed in the medical coding profession and the healthcare information technology sector in general.
Private doctor’s offices may hire medical billers and coders to perform their functions and send invoices to insurance companies and patients. Because doctors and nurses may be more focused on direct patient care, billers and coders who have been educated and trained in this specialty are hired to take care of this administrative work. Both medical billers and medical coders have undergone the education needed to find work in this field. Students may enter this profession with either an associate degree in the field or after having completed a certificate program.
Steps to Becoming a Medical Biller and Coder
Medical coding is the process of converting each healthcare diagnosis, procedure, medical service, and medical equipment used into alphanumeric codes for storage and transfer. These codes are universal, which means they are used by all medical providers across the country. The certified professional coder is responsible for converting doctors’ reports into medical codes that are understandable to insurance companies. Because regular English isn’t precise enough, a specific code was established to help medical coders and insurance companies define the medical procedures and equipment used in a medical appointment.
A medical biller fulfills the duty of being the liaison between the doctor and the patient’s insurance company as well as entering data into the general healthcare system in order to track a patient’s diagnosis and treatments. They are an important part of any medical office as they make sure the practice receives payment from the insurance company.
These specialists may also handle workers’ compensation claims, ensuring the doctor is paid for services provided to the injured person and providing necessary information to the company without breaking HIPPA rules. They interact with a variety of commercial claims companies such as Medicaid, Medicare, Blue Cross, Blue Shield, and others as well as Tricare, which is the insurance services offered to members of the military and their families.
Because their interactions may require them to contact so many insurance companies, they need to learn about how each company functions. They may need to know which insurance providers are government funded, which ones are private, and what processes they can expect to be followed in payment processing and timing.
The degree programs from which a medical biller graduates teach students about insurance guidelines for both private insurance organizations and government providers. They need to be familiar with ICD-10 and CPT coding and have proficiency with financial software 10-key calculators and computers.
Step 1: Education Requirements
Step 2: Internship or Apprentice
Step 3: Licensing & Certifications
Step 4: Continuing Education and License Maintenance
Step 1: Education Requirements
Students should be aware of what the prerequisites or requirements are likely to have to meet if they are looking for admission to a community college or trade program. For one thing, they need to have a high school diploma or its equivalent (GED). Because of the nature of the work they will be doing, they must also pass a background check. Any applicants to these programs who has a history of drug-related offenses or sexual crimes will be rejected.
Once they are accepted, they’ll be ready to start their education and training. This may be a postsecondary certificate, though some employers require that their coders and billers have an associate degree in the field. Certificate programs may last for a year or up to 18 months. Once the student finishes, they’ll have to take and pass their certification exam in order to enter the profession. If they opt for the associate degree, they will be in school for closer to two years.
A few of the coding courses students should expect to take include:
- Coding Foundations
- ICD-CM Coding
- ICD-PCS Coding
- Revenue Cycle and Billing
- Ambulatory Care Coding
Students should gain adequate experience in both the Healthcare Common Procedure Coding System (HCPCS) and Current Procedural Terminology (CPT) codes while in school. While they are in their certificate or degree program, they should get some practical training and a good understanding of what the field is about and be fully prepared to enter the field when they graduate.
Step 2: Internship or Apprentice
Medical billing and coding students are likely to improve their chances of getting a job by going through an internship. This could be at a medical practice or hospital that may later offer them a job after graduation.
If that doesn’t happen, they can use their internship as an opportunity to learn and apply their classroom learning in a real-world, on-the-job experience.
During their internship, the student will have the chance to use coding programs, medical terminology, and their classroom experiences to gain experience in inputting correct codes into patients’ medical charts. As they prepare to enter the healthcare industry, they can use this as an opportunity to prove that they will be valuable to healthcare professionals and to their internship placement facility.
As you can see, an internship in medical coding or billing can be very valuable. While the student isn’t in the classroom, listening to an instructor, they will be pulling together everything they have already learned: using the terminology and actually practicing their skills. Once they graduate, they will be able to demonstrate that they know how to use everything they’ve learned as they enter the medical industry.
Step 3: Licensing & Certifications
Medical billers and coders are required to obtain medical coding certification. They should have been able to choose between a wide range of certificate programs when they began their training. These programs will help you learn material related to the different coding manuals including coding courses in CPT, ICD-10-PCS, HCPCS, and ICD-10-CM.
Medical coders and medical billers should choose the right certificate for their professional needs. These certifications include the Certified Professional Coder (CPC), Certified Professional Coder Payer (CPC-PU), Certified Interventional Radiology Cardiovascular Coder (CIRCCU), and Registered Health Information Technician (RHIT).
The American Association of Professional Coders (AAPC) and the American Health Information Management Association (AHIMA) both provide medical coder training and courses. Their certifications run across disciplines and levels.
The Certified Professional Coder CPC exam proves that professionals show a high level of competency in medical coding, which can be used within any type of facility. Only once the student or coder has finished their training are they able to register for this exam, which, if they earn the credential, can increase their earning potential by at least $20,000.
Other certifications include Certified Outpatient Coder, Certified Inpatient Coder, and Certified Risk Adjustment Coder.
Step 4: Continuing Education and License Maintenance
Professionals who are new to the medical coding & billing field may want to consider how they can continue their certification education so that they can maintain their license and continue to improve their healthcare careers.
The AAPC offers preparation courses for exams related to medical billing and coding. These include accounts receivable, insurance, data entry, Medicaid and Medicare billing, and general billing. Medical coders who learn surgical coding or orthotics fitting may also earn additional continuing education credits.
A certified coding specialist who learns skills in ICD-10 Coding, CPT Coding, EMR Coding, and Medical Coding may be able to see their annual salary going up as well. The ICD-10 (International Statistical Classifications of Diseases) may pay result in higher-than-average pay.
Billing and coding specialists who earns certification in electronic medical records (EMR) coding will also be learning a valuable skill that is becoming more and more necessary in the industry. Their salary is also likely to increase.
Where Do Medical Billers and Coders Work?
Medical billers and coders may work in hospitals, outpatient centers, doctors’ offices, or other medical facilities. Due to the need for patient confidentiality, they usually work on-site but in an office set up for their work needs. From the moment the patient is seen by the nurse before the doctor comes in, medical issues, medications, and treatments are discussed. It’s up to the medical billers and coders to assign the correct codes to every one of the medical services so that, when the invoice arrives at the insurance company, the employees and supervisors there know just what procedures the healthcare provider used. This allows them to refer to the patient’s insurance coverage and make specific decisions on how much of a procedure to cover and what to send through and bill to the patient.
The coder researches the codes to find and assign the right ones. They can do this using several books which hold all currently used medical codes or they may use special medical coding software to complete their work. In today’s healthcare settings, 19% of the country’s medical coders work in doctors’ offices, more than one-third work in hospitals, and 5% work in nursing care facilities.
Why Become a Medical Biller and Coder?
Working in the healthcare field can be a very rewarding career. A student who chooses this field should understand that, without their knowledge and experience, it would be difficult for patients to get to the healthcare they need.
Once students learn which schools offer education and degrees in this field, they can find the right program for their needs and career goals. Because this career is often offered by community colleges and trade schools, students should take advantage of this opportunity. If they are able to earn an associate degree as medical coders or billers, they should be able to find a job relatively quickly. While a coding specialist doesn’t work directly with patients, they are still a valuable member of the team. After they have received some on-the-job training and have more experience, they should be able to work more independently.
Professional organizations have been created for professions like accounting, social work, and medical billing and coding. These organizations work to improve the ability of their professionals to access and obtain the continuing education credits they need, earn certificates or licenses, and even meet with each other and network with health professionals. A profession such as medical billers and coders benefits from professional organizations because of the skills they can learn and the access they can find to job boards, publications, certifications, and more.
- American Academy of Professional Coders (AAPC)
Founded in 1988, AAPC works to provide both education and professional certification to coders who work in physician-based offices. It also strives to elevate medical coding standards with the provision of training, additional certification, continuing education, job opportunities, and networking.
- Healthcare Billing & Management Association (HBMA)
HBMA was founded by a group of individuals with a vision of an association able to guide members to resources and move their collective efforts toward gaining a positive professional image in the medical community. It is a big voice in the revenue cycle management industry and the group is recognized as a revenue cycle management authority.
- American Health Information Management Association (AHIMA)
AHIMA is the foremost voice of authority in the health information field. The organization’s mission works to protect sensitive health information and stories are accurate, protected, accessible, and complete. During the COVID-19 pandemic, AHIMA stood at the front of the non-profit associations to empower people—this is the organization’s underlying mission. Its vision is of a world of trusted information transforming both health and healthcare.
Medical Biller or Medical Coder Career, Salary and Advancement Outlook
The average base salary for a medical biller is $40,000. At the earliest points in their career, this is $30,000 and, at the later points in their career it is $57,000.
The expected job outlook for this occupation shows that the field is expected to grow 8% between 2019 and 2029. This is driven by the aging of the U.S. population. These individuals will need more medical services as they grow older. Professionals such as medical billers, coders, and other health information specialists will be necessary to help organize and manage their health information, especially as electronic health records become the norm and information technology suffuses every part of the healthcare industry. In addition, medical providers will be filing more reimbursement claims to their patients’ health insurance companies.
Medical coders earn an average annual salary of $52,000. The rate of job growth from 2019 to 2029 is the same as for medical billers. Medical coders will be needed to help convert and generate more patient records into electronic health records (EHRs). This will happen across the range of specialties, including at hospitals and long-term care facilities. The medical coders who work for these medical providers will be involved in organizing and managing the information of each person.
Certified coding specialists can expect to earn close to the average of $50,000 annually. Their early-career salaries are $35,000, on average, and their late-career salaries increase to $74,000.
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Frequently Asked Questions
What is the job outlook for a medical coding and billing specialist?
Employment of medical coding and billing specialists will grow 8% from 2019 to 2029 according to the Bureau of Labor Statistics.
How can medical coders and billers increase their salary potential?
The quickest way to advance your salary is education. A number of certifications are available to enhance your skillset. Another important thing is networking.
What personal skills are helpful for a medical biller and coder?
A medical biller and coder needs to be accurate and has a strong attention to detail. They must also be good at problem solving, working in a team, accounting, bookkeeping, medical terminology, and have computer knowledge.
What are the salary trends for medical coding?
The salary trend for medical coding continues to increase by 5.8% according to the 2019 General Industry Salary Budget Survey.
What is the average medical coder salary?
The average annual salary for a medical coder is around $53,051 annually but with additional credentials that salary can raise to $63,085.
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