What It’s Like to Be a Medical Biller or Coder
Are you considering a career in medical billing and coding and not quite sure what those jobs really entail? Nurse.org has partnered with Victoria Moll, of Contempo Coding, to show you what a day in the life of a medical biller or coder looks like. Watch her video to find out what these jobs are actually like, or read the transcript below.
I'm Victoria Moll. I'm a medical coder, auditor, educator, content creator, national speaker, and I'm most popularly known for my YouTube channel, Contempo Coding. You can find me on Instagram and Tik Tok @ContempoCoding.
What is Medical Coding?
Medical coding is the process of reading medical records, reviewing them, analyzing them and abstracting all of the different diagnoses, services and procedures, and then translating them into different code sets.
What is Medical Billing?
Medical billers, then take those codes and make sure that they are submitted to the insurance company to get the complete reimbursement for all the services that were rendered.
A medical biller is responsible for reconciling all of the billable services, getting them onto a claim form, and making sure that they are submitted timely to the insurance.
What Do Medical Billers Do?
Medical billers are really the insurance experts. They know all the different insurance guidelines.
- They know how to get them submitted cleanly and paid at the appropriate amount.
- They know what amounts they should be paid at
- They know the general billing guidelines and federal guidelines.
- How to handle if a patient has two insurances to know which one pays first and which one pays second
- They know things like how long they have to submit an appeal when a claim is denied.
Medical billers make sure that everything that was done, all of the great services that were provided by hospitals or providers that we can bill out to insurance, get paid and they get paid at the maximum amount.
And they work all of those denials to make sure what they can do to get those paid.
Medical billers are also really great at patient advocacy. They want to make sure that the patients are not paying out of pocket for services that the insurance companies should really be paying for.
So they are willing to work very hard with these insurance companies, proving things like a medical necessity, pulling out records, working with the provider so that they can reduce some of that patient burden and make sure that the insurance companies are the ones paying for the services when they're medically appropriate.
Who Do Medical Billers Work With?
Medical billers work with a number of people including:
- The revenue cycle staff
- Department managers
- Office managers
- Practice managers.
Where Do Medical Billers Work?
A lot of medical billers can work from home. They work for insurance companies, billing companies, they work for healthcare organizations.
A lot of them do also work onsite, oftentimes in very large building offices or they're embedded somewhere within that hospital or healthcare organization.
What Do Medical Coders Do?
Medical coders are responsible for reviewing records. It involves a lot of reading. A lot of interpreting records, pulling out what services were provided, what procedures were done, and what diagnoses the patient has, and then translating them into code sets.
For example, this book right here is ICD-10 CM, and it's for diagnosis coding. Now, there are different services for electronic medical records and we call encoders that can help guide you a little bit through the medical coding process, but there's so much involved in regulations, compliance, very unusual guidelines for medical coding.
So it's not just a one-to-one match, like looking up something in a phone book, it really is analyzing, reviewing, and deep-diving into the medical records to get things coded to the highest specificity and highest accuracy.
Who Do Medical Coders Work With?
Medical coders work with a lot of the same people that billers do. They might also work closely with people who are doing pre-authorizations for surgery.
Coders work a little bit closer with physicians and billable providers, because if they see something in the documentation that wasn't specific enough, was omitted, was unclear, or they need to have tweaked so that they can get a better code submitted to show the appropriate picture of what happened to this patient, they’ll need to check with them.
Where Do Medical Coders Work?
Coders also work for insurance companies, billing offices, health insurances. They could work for small private practices or large healthcare organizations. There are large companies that just do revenue cycles, so they just hire billers and coders. They could even become instructors and train in medical coding.
As you advance in medical coding, you can go into things like compliance and auditing. I have friends that make really good careers out of working in the legal sector of medical coding.
Day in the Life of a Medical Coder
1. Go Through Your Work Queue
Oftentimes, coders and billers will have what they call a work queue. It's just a listing in the practice management software or electronic medical record that has all of the names of the patients and the dates of service they were seen. The medical coder clicks on them, pulls them up, looks through the chart, abstracts all the information, submits, all the claims, sends it out, and then goes to the next item in their work queue.
A medical coder might have reports that they pull. They might pull a certain provider name and date range and say, "I want to look for all of Dr. Smith's services from last week," pull everything that Dr. Smith did last week, and code out all his services.
Or, they might have a listing that's sent to them by a practice manager. The practice manager pulls a report and forwards it over via email to the coder of all the things that they're supposed to code and send out.
2. Follow Up On Code Issues
Oftentimes, it doesn't end there. It isn't just, "Oh, I coded it, it's out the door and now we're done."
Medical coders have to work with the billing staff and the revenue cycle staff if something hits a snag such as:
- Finding a more specific diagnosis so that it can get it paid through the insurance
- If they find out this patient doesn't have this diagnosis.
- Things that get denied because of incorrect coding
3. Quality Checks
Some coders just do quality checks for providers. If the provider builds their own office visits then sometimes the coder goes through and checks on them to make sure that they're submitted accurately before they go out the door.
Or, they might just review some of the higher-risk things. Things that they know are likely to get denied, they review specifically those high-risk items before they go out the door.
Day in the Life of a Medical Biller
Medical billers have a lot of work with insurance companies. Oftentimes, they'll get reports of denials and they'll work with maybe sets of insurance companies.
They will call up Medicare, work through portals, and try to find the reasons why these claims were denied, or why they weren't paid at the full amount.
Some of the other things they focus on include:
- Denial Reviews
- Working with insurance companies
- Timely filing reports
- Insurance Appeals
What You Need to Know Before Getting Into a Career in Medical Billing or Coding
1. It’s a Desk Job
One of the things you really need to know before deciding to get into a billing or coding career is that this is a very desk-heavy job.
You are probably spending 95% of your day sitting at a desk, working in different systems on the computer.
2. Medical Billers Can Make a Real Difference
Medical billers can be really great patient advocates and help with some of those financial strains that patients can have because of medical bills.
Medical bills are actually one of the number one sources of bankruptcy in the United States because of how expensive they are. Medical billers are challenged with the task of analyzing these medical bills and determining if this is something that the insurance company should have paid for and how to get them to make that payment for this medically necessary service.
3. Medical Coding Offers A Lot of Variety
Medical coding has a great variety of things that you can do. Coders can specialize in just about every different specialty: gastroenterology, pediatrics, internal medicine, surgery, bariatrics, plastic surgery.
Any specialty you can think of, you can specialize in as a medical coder.
4. Working From Home Can Be Lonely
If you're a medical coder working from home, you can sometimes deal with things like isolation. The good news is, there are lots of great associations you can join that you can participate in. You can meet with other medical coders and go to virtual meetings.
There are also big conventions that happen in medical coding that you can attend.
5. Medical Coders Have a Lot of Opportunities for Career Advancement
There's lots of career advancement available for medical coders. You can get into teaching, consulting, and auditing. You can get into legal stuff with the medical coding and advocate for patients on that end by making sure that the court cases have accurate coding.
6. Medical Coding Can Be For Introverts and Extroverts
A lot of medical coders are introverts. There's always going to be a place for people who just want to be behind the scenes, look through the medical records, submit the codes and work with that.
But the coders that are more willing to partner with providers to have those difficult conversations -- do things like audits, talk about their process improvement, their documentation improvement -- those coders tend to have much more lucrative careers.
Medical Billing Pros and Cons
Easier to get into
Medical coding jobs can be hard to get into as a new coder. But billing jobs are easier to get. In fact, a lot of medical coders have to start out in medical billing before they get into coding.
Medical billing usually doesn't pay as much, at least to start, as medical coding. There are positions you can grow into, like supervisor positions, or revenue integrity, but an initial medical biller position typically doesn't pay a whole lot of money.
Medical Coding Pros and Cons
Hard to Get Into
The con about medical coding is that it can be hard to get into. It's not like nursing where you've done certain clinical skills and demonstrated them. With medical coding, what employers are really looking for is that medical coding certification through AAPC or AHEMA.
Because of that, employers tend to be a little bit more reluctant to hire new coders because they're not sure if they really just knew how to pass the exam or have the skills needed to code in person.
So, if you're looking for something that you can get into easier and work on the backend, medical billing might be better.
Medical Coding Pays More
As I mentioned, medical coding typically pays more than medical billing.
It also offers more opportunities for career advancement than medical billing.
If you love doing analytics, record review, and working with providers, medical coding is a fantastic job!
I hope that helped clarify some of the differences between medical billing and medical coding, and facilitated you making a decision about whether or not this is a career that you might want to get into.
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