Making the decision to work in healthcare is a very smart move, especially if you’re considering a career as a medical biller or coder. You're choosing a field that makes a difference in people’s lives, is in high demand, and often offers a flexible work environment with the ability to work from home.
This helpful guide has been put together to provide you with the answers you need about a career in medical billing and coding.
Part One What Is Medical Billing and Coding?
When you go for any kind of medical service, whether it’s a well checkup, a mammogram, an X-ray or anything else, there are people who provide your care, and another group behind the scenes who are doing the administrative work, including medical coding and billing professionals.
Medical billers and coders translate the diagnosis and treatment from your healthcare provider into standardized codes that get sent to insurance companies and government agencies. These are used so that they can pay for the care that you received and the tests and procedures that were ordered and administered.
Medical billers and coders work collaboratively to make sure that all of the data in your medical records is input correctly in order to make sure that their employers –- the healthcare facilities –- are quickly paid the correct amount that they are owed for the services the healthcare professionals provided.
In order to do their jobs, billers and coders need a thorough understanding of how the medical insurance system works, how to code the information correctly to expedite claims, and what to do if a claim is denied. Their specialized knowledge, skills and efficient job performance make them a valued member of every healthcare team.
Part Two What Does A Medical Coder Do?
Medical coding is the first step in recording patient data, both for patients’ medical records and for billing purposes.
Medical coders are trained in intricate classification systems that have been created by the healthcare system to translate medical information into codes that are then input into billing systems and patient’s medical records.
These classification systems are ICD-10-CM, HCPCS Level II and CPT. The process allows everybody who touches a patient’s records to have a universal understanding of the patient’s diagnosis, as well as the tests and procedures that were ordered and delivered. It is the medical coder’s job to make sure that the correct code is identified and recorded.
Part Three What Does A Medical Biller Do?
Once a healthcare provider has provided services to a patient, a bill needs to be submitted for payment. These bills get sent to insurance companies and government agencies, as well as to patients, and it is essential that they are accurate in order to facilitate quick payment.
It is a medical biller’s responsibility to read and review medical records that may or may not have already been coded and translate them into a bill. They then have to keep track of the bill to make sure that it gets paid.
In order to ensure accuracy and quick reimbursement, medical billers may be responsible for gathering patient and insurance information before the patient is seen to make sure that coverage is provided, get preauthorizations if needed, collect patient payments, and check all billing for accuracy before submitting it. Medical billers also record payments as they are received.
Part Four Medical Billing and Coding Salaries
Though the two positions each have their own unique skillsets and responsibilities, medical billers and coders earn roughly the same amount and are both classified as health information technicians.
According to the annual salary survey conducted by the AAPC (American Academy of Professional Coders), the average medical coding salary for both certified and non-certified coders is $54,890, with certified coders earning 33% more than non-certified coders.
How to Earn More Money as a Medical Coder or Biller
Those who choose this profession are able to realize significant increases in salary by pursuing additional credentials:
- Coders with one certification earn an average of $55,923 per year
- Those with two certifications earn an average of $64,890 per year
- Those with three or more credentials earn an average of $70,608 per year
These earnings are generally accompanied by whatever benefits are offered by the employer, and generally include health and life insurance coverage, disability insurance, vacation time and sick leave, and retirement plans. Some employers offer childcare reimbursement, tuition reimbursement, and other perks.
Part Five How to Start Working in Medical Coding and Billing
One of the most appealing aspects of medical coding and billing is the fact that you can earn your certification and start earning a competitive salary in less than one year.
There are no requirements to have either a 4-year or 2-year degree: Instead, medical billing and coding students take specific classes that provide them with the training and knowledge that they need to fulfill the job’s important responsibilities.
What You’ll Learn in a Medical Coding and Billing Program
Both medical billing and medical coding certifications require that students learn federal coding standards in:
- CPT (Current Procedure Terminology standardized by the American Medical Association)
- ICD 10-CM (Coding standards for diseases and disorders issued by the Centers for Medicare and Medicaid Services)
- HCPS (Coding standards for medical services and supplies issued by the Centers for Medicare and Medicaid Services),
Because of the similarities between the two careers, some programs combine billing and coding into a single curriculum that provides dual certification. If you prefer to pursue just one path, there are differences between the two curriculums.
Medical Billing Program Courses
The Medical Billing curriculum will include coursework in:
- Medical Terminology
- Medical Insurance Principles
- Medical Reception
- Medical Billing Technology
Medical Billing Certifications
These courses prepare you for taking tests to provide the following credentials:
- Certified Professional Biller (CBP) issued by the American Academy of Professional Coders
- Certified Medical Reimbursement Specialist (CMRS) issued by the American Medical Billing Certification
- Certified Medical Billing Specialist (CMBS) issued by the Medical Association of Billers
Medical Coding Program Courses
Medical Coding curriculum will include coursework in:
- Medical Office Procedures
- Medical Records
Medical Coding Certifications
These courses prepare you for taking tests to provide the following credentials:
- Certified Professional Coder issued by the American Academy of Professional Coders
- Certified Coding Associate (CCA) issued by the American Health Information Management Association
- Certified Coding Specialist (CCS) issued by the American Health Information Management Association
- Certified Coding Specialist: Physician-based issued by the American Health Information Management Association
Part Six Medical Coding and Billing Certification Programs
Both medical coding and billing certification programs are available either online or in person, and each offers its own advantages and disadvantages.
While learning in a traditional classroom setting provides the benefits of face time with an instructor and other students and hands-on training, it also requires that you adhere to the institution’s schedule. This may limit access for those who do not have a program nearby, or who are pursuing their education while also working at another job or attending to family responsibilities.
By contrast, online training programs offer scheduling flexibility that allows you to study when you are available as long as you complete your coursework. You can access programs anywhere without leaving your home, and these programs are often less costly.
Unfortunately, you give up access to face-to-face support from teachers and the comradery of interacting with fellow students, and you need access to technology and an internet connection.
Part Seven Where Do Medical Coders and Billers Work?
Working as a medical biller or coder provides both stability and flexibility. Most people in this profession work whatever type of shift they prefer, either full-time or part-time, and though you can work a typical 40-hour week in any type of medical facility, you can also choose to work as a freelancer in the comfort of your own home.
Typical work environments for medical coders and billers include:
- Doctors’ offices
- Outpatient surgery centers
- Nursing homes
Medical coders and billers can also work in less traditional settings. Many work for insurance companies, where they verify incoming claims. Some work for law firms, interpreting medical records as part of insurance fraud investigations or within the scope of personal injury litigation. Others work for government agencies, collating information that is used for setting national or local healthcare policy.
Part Eight Medical Coding and Billing Jobs: Employment Rate by State and City
When considering a new career, one of the most important factors to be weighed is whether you’re likely to be able to get a job where you live, or where you want to live.
As of May 2019, the BLS indicated that there are 215,500 medical records specialists and health information technicians working in the United States, and the five states with the highest level of employment of these professionals are:
- New York
The metropolitan areas with the highest levels of employment for these professions are:
- Los Angeles/Long Beach/Anaheim, California
- New York/Newark/Jersey City New York/New Jersey
- Chicago/Naperville/Elgin Illinois/Indiana/Wisconsin
- Dallas/Fort Worth/Arlington Texas
- Houston/The Woodlands/Sugarland Texas
The five states paying the highest annual mean wage for medical billers and coders are:
- District of Columbia
Part Nine Where Can I Learn More About Medical Billing and Coding
As you can see, there are many things to recommend a career in Medical Billing and Coding. The profession takes only a small investment in time in order to reap significant rewards, job security and opportunity for growth and advancement.
For more specific information, the best resources are the professional organizations that are dedicated to advancing the profession. These are:
- The American Association of Professional Coders (AAPC)
- The American Health Information Management Association (AHIMA)
- The Medical Association of Billers (MAB)
Part Ten Why Should You Start a Career in Medical Coding and Billing?
There are many things that make a career in medical coding and billing worthwhile. In addition to offering competitive compensation and a career with certain job stability in exchange for a small investment of time, there are many other benefits to working in healthcare.
- Medical billers and coders are valued and respected members of the healthcare team.
- The work that they do is what keeps revenue flowing into the organization and allows clinical staff to concentrate on providing patients with attentive care.
- The job offers tremendous flexibility in terms of work environment, including the ability to work from home.
- As the population continues to age there are more and more people in need of healthcare, and many of those already working in the field are beginning to retire, so there are plenty of opportunities and job stability.
- Healthcare facilities are everywhere, so no matter where you want to live or what type of setting you want to work in, you are likely to find employers eager to hire someone with your skills.
- Once you’re in the field you’ll find plenty of room to grow, either by moving into management or transitioning into a hands-on caring position like nursing.
- Perhaps most importantly of all, medical coders and billers perform work that can make a real difference in patient health and outcomes.
Though they are not performing hands-on care, the information that they code and record becomes a vital part of the patient’s medical history upon which physicians and other medical professionals rely.
Part Eleven Medical Coding and Billing FAQs
How long do you have to go to school to be a medical coder or biller?
- Depending upon whether you choose to pursue an in-person program or an online program, becoming certified as a medical biller or coder can take as little as four months or as long as fifteen months. There are a variety of advanced certifications that can be pursued that will take additional time, but basic entry into the field generally takes less than a year.
Is medical billing and coding hard?
- As is true of any skill, medical billing and coding is only difficult before you learn how to do it. Coders and billers are taught the process of using reference books, software, and the basics of anatomy, physiology, and medical terminology so that they can confidently apply that information to their jobs.
What does a medical coder do all day?
- Medical coders and billers generally work in office settings. They begin their day by checking their email and voicemail messages, then log into their employer’s database system before beginning to process the patient charts that accumulate throughout the day as patients are seen by the clinical staff. Each chart is examined with the intent of labeling and assigning the correct diagnostic and procedure codes for submission to insurance companies, Medicaid or Medicare, workers’ compensation, or other payers.
How much does medical coding and billing pay?
- The average annual salary for medical coders and billers is $54,401 with an annual growth rate of 9 percent.