Medical Billing and Coding

Medical Billing and Coding

If you’re interested in healthcare but prefer to work in a business atmosphere, then starting your  healthcare career in the Billing and Coding area may be just the job for you. You will need both good communication and computer skills.

Description of  the daily work:

Billers and Coders work in hospitals, clinics, doctor’s offices, and insurance companies. They usually work in the billing office, medical and claims processing offices, or in the billing department. You will play an important role to ensure that all patient accounts are properly billed on a timely basis to insurance companies, government agencies, or patients directly so that the organization can be reimbursed for its services. You will review patient accounts and records, gather and organize all material required to process initial billing, verify billing data, and resolve problems presented by patients or their representatives. You will also follow up on the overdue accounts, resend bills to insurance and government payers, answer patient questions, and solve routine billing questions. Coders are responsible for ensuring that every contact between a health care provider and a patient is accurately recorded or coded. These codes tell the payer, the health insurance companies, or the government the reason why the patient was seen and what services were performed. Accurate medical coding is essential to medical record keeping because that is how a health care provider is paid.

As a Medical Biller, in particular, you use your customer service skills when contacting patients and insurance companies. Billers must be able to communicate effectively over the phone to explain charges, deal with criticism, and give and receive feedback. For both Medical Billers and Coders, your daily tasks will involve database management, creating, maintaining, and analyzing spreadsheets, and retrieving and saving electronic mail.

Medical Billers and Coders typically work a regular 40-hour week, Monday through Friday, during standard business hours.

Education Requirements, Licensure/Certification:

A high school diploma or equivalent is required and most organizations require at least one year of work experience where you had some exposure to third party payer procedures. You can also obtain this knowledge by attending a business school or community college program for billing and coding. A Medical Billing and Coding program provides students with classroom instruction and practical experience in a medical or insurance facility. The program provides knowledge and skills needed to accurately report, transmit, and track claims. You will need to have a good understanding of medical terminology, be able to organize and prioritize work to meet deadlines, have good computer skills including PC applications, be self-motivated, service-oriented, and have excellent communication skills (written and oral).

In preparation for a job as a Medical Biller or Coder, it is recommended in High School to take courses such as computers, typing, English, business classes, science courses, or health care related courses. Training of medical coders can range from two to four years of college, a technical school diploma, and certification from correspondence courses, to a home study program. Upon completion of such training many coders may seek professional certification.

Currently there are no rules or regulations that require that Medical Coders and Billers must be certified. However, employers are more likely to recruit certified versus non-certified workers. Various schools, training institutions, and associations offer certification examinations. Salary surveys show that workers with certification generally earn more than those without certification.

The following credentials are offered by the American Health Information Management Association (AHIMA) through its national certification examinations:

  • Certified Coding Associate (CCA) requires a high school diploma or GED; a certificate program in coding is preferred.
  • Certified Coding Specialist (CCS) requires a high school diploma or GED; a certificate program in coding is preferred and coding work experience is required.
  • Certified Coding Specialist (CCS) requires a high school diploma or GED; a certificate program in coding is preferred and coding work experience is required.

The American Academy of Professional Coders provides two certifications for Coders. The awarding of the credential is based on successful completion of an examination and work experience. To be eligible to take the Certified Professional Coder examination, you must have at least two years coding experience and maintain yearly renewal and continuing education requirements. Certified Professional Coder (CPC) is for Coders working for physician services.

  • Certified Professional Coder-Hospital (CPC-H) is for Coders working in outpatient facility coding.
  • Certified Professional Coder-Hospital (CPC-H) is for Coders working in outpatient facility coding.

The National Healthcareer Association also administers an examination leading to certification for Billers and Coders.

  • Certified Medical Billing and Coding Specialist (CBCS) To be eligible to take the examination, you must be a graduate of a healthcare training program, or have one or more years of full-time job experience.

Career Path and/or Opportunities for Growth:

Experienced Billers and Coders can use their skills to progress in specialized areas of billing, transition to compliance positions, or move into supervisory or management positions. Your billing expertise can be applied to many other areas as your career progresses. Other specialties closely related to the medical billing and coding profession include: Patient Account Representative, Electronic Claims Processor, Billing Coordinator, Reimbursement Specialist, Claims Assistant Professional, Medical Claims Analyst, Medical Claims Processor, and Medical Claims Reviewers.

Besides working in a medical office as an employee, Medical Billers and Coders are also able to work independently out of their home from a home-based billing office. With a home office computer, you can easily set up electronic billing programs. In addition, it is possible to become an independent insurance specialist or consultant who helps patients understand their insurance bills and what they should be paying.

The recommended career track for a coding specialist is to work in the field for two years before taking the CSS or CSS-P exam administered by the AHIMA. Both certifications represent mastery in clinical coding and must be maintained on an annual basis. This will lead to jobs with more responsibility and greater pay.