The healthcare industry is booming, and within it, medical billing and coding specialists are in high demand. This field is recognized as one of the fastest-growing occupations in the United States. According to the U.S. Bureau of Labor Statistics (BLS), under the broader category of medical secretaries, this sector is projected to experience an 8% employment increase between 2021 and 2031, translating to approximately 53,600 new job openings. This surge is largely driven by the increasing healthcare needs of an aging population.
Every healthcare provider, from hospitals to private practices, relies on efficient medical billing and coding to manage their revenue cycle. While some healthcare professionals or office managers might handle these tasks alongside their primary duties, the complexity and importance of accurate billing and coding often necessitate dedicated specialists. Clinical staff are primarily focused on patient care; therefore, the critical administrative functions of billing and coding are typically entrusted to trained professionals to ensure healthcare providers receive proper reimbursement for their services.
If a career in a stable and growing field with crucial responsibilities appeals to you, then exploring the role of a medical billing and coding specialist might be a perfect fit. Let’s delve into the specifics of this profession and what it takes to succeed in this expanding industry.
What Does a Medical Billing and Coding Specialist Do?
A medical billing and coding specialist serves as a vital link between healthcare providers and insurance companies. Their role is essential for the financial health of any medical practice or healthcare facility.
But what does this entail on a daily basis?
Essentially, a billing and coding specialist is responsible for managing the financial transactions between a healthcare facility, patients, and insurance providers. The typical tasks in a medical coding and billing career job description include:
- Accurate Coding: Translating medical services, procedures, diagnoses, and treatments into standardized alphanumeric codes. This is a critical step for proper billing and record-keeping.
- Claims Preparation and Submission: Preparing and submitting invoices or claims to insurance companies and patients for services rendered. Accuracy in claim submission is paramount to avoid delays or denials.
- Claims Management and Correction: Handling rejected claims, identifying errors, correcting them, and resubmitting claims to ensure payment. This requires problem-solving skills and attention to detail.
- Payment Tracking and Reconciliation: Monitoring payments from insurance companies and patients, and reconciling payments with outstanding balances. This ensures accurate financial record-keeping.
- Follow-up on Outstanding Payments: Communicating with patients and insurance companies regarding outstanding balances and resolving payment issues. This often requires effective communication and customer service skills.
While medical billing and coding specialists are integral to the healthcare setting, their work environment is primarily office-based rather than directly involved in patient care. A significant portion of their workday is spent at a computer, working with specialized software to review, enter, and update patient and billing information.
Medical Coding vs. Medical Billing: Understanding the Difference
Although “medical billing and coding” are often combined into a single job title, they are technically distinct functions, each with specific responsibilities and tasks. In many smaller healthcare settings, one individual may handle both roles. However, larger facilities might have separate positions for coders and billers. Understanding the nuances of each role is key to understanding the full scope of a Medical Billing And Coding Career Job Description.
What Does a Medical Coder Do?
Medical coding is the process of transforming a healthcare provider’s notes on diagnoses and procedures into standardized medical codes. These codes are essential for tracking patient records, statistical analysis, and, crucially, for the medical billing process. Medical coders must possess a comprehensive knowledge of various coding systems.
These include:
- CPT (Current Procedural Terminology): Codes for medical, surgical, and diagnostic procedures and services.
- ICD-10-CM (International Classification of Diseases, Tenth Revision, Clinical Modification): Codes for diagnoses and diseases.
- HCPCS (Healthcare Common Procedure Coding System): Codes for procedures, services, and supplies not covered by CPT codes, such as durable medical equipment, prosthetics, and ambulance services.
Each of these coding systems has specific guidelines for accurate application and placement within billing software. Coders must stay updated on coding changes and regulations to ensure compliance and accuracy.
Coding can begin as soon as a patient appointment is scheduled. Initial codes might be assigned for the type of visit and the patient’s reported symptoms. As the patient proceeds through their visit, further codes are added to reflect observed symptoms, tests performed, diagnoses made, and treatments administered. The coder’s meticulous work ensures that all services are accurately documented and ready for the billing process.
What Does a Medical Biller Do?
Once medical coding is complete, medical billers take over to generate invoices and submit claims to insurance providers and patients. Using the codes provided by the medical coder, billers initiate the financial recovery process for the healthcare provider. Insurance companies then review these claims and decide to approve or deny payment based on factors such as coverage and medical necessity. Any portion not covered by insurance becomes the patient’s responsibility.
The billing cycle often starts early in the patient journey, sometimes even when the appointment is booked. Pre-authorization codes might be submitted to insurers to determine patient out-of-pocket expenses upfront. This allows the office to inform patients of their estimated costs at the time of service.
Even if a medical biller doesn’t personally perform coding, a solid understanding of medical codes is vital. Billers must review denied claims, understand the reasons for rejection, and potentially modify codes before resubmitting. They also verify the accuracy of codes on initial claims to prevent errors and delays.
After insurance processing, billers handle patient invoicing for remaining balances. They also manage co-pay collections, track payments from both insurers and patients, and follow up on overdue payments. In cases of unpaid bills, billers are responsible for contacting insurance companies to resolve claim issues and reaching out to patients for payment. For persistently unpaid patient balances, a biller may need to initiate collections processes, including referring debts to collection agencies.
Combining Medical Billing and Coding
The interconnected nature of billing and coding often leads healthcare facilities to seek professionals trained in both disciplines. These “medical billing and coding specialists” are valuable assets, capable of managing the entire revenue cycle process. While larger healthcare organizations may have separate billing and coding departments, close collaboration between these teams is crucial for a seamless and accurate process. The primary goal is to minimize errors in both billing and coding to ensure timely and accurate payments, which is essential for the financial stability of healthcare providers.
Other Requirements
While specific job titles and duties may vary, the core requirements for medical billing and coding careers tend to be consistent. Beyond coding knowledge, several other skills and areas of expertise are highly valued by employers.
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Medical Terminology: A foundational understanding of medical terminology is indispensable for accurate coding. This includes knowledge of anatomy, physiology, medical procedures, diagnoses, and treatments. Familiarity with common medical terms ensures coders can correctly interpret medical documentation.
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Basic Math Skills: While billing systems often automate calculations, basic arithmetic skills are still necessary. Billers may need to manually calculate patient balances, co-pays, and payment plan amounts.
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Computer Skills: Proficiency in computer systems and relevant medical billing software is essential. Medical billing and coding is a computer-based profession, requiring comfort with data entry, software navigation, and electronic health records (EHR) systems. Adaptability to learn new software programs is also a significant advantage.
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Communication Skills: Effective communication is crucial, particularly for medical billers who frequently interact with patients and insurance companies. Professional and clear communication is needed when discussing bills, payment issues, and insurance claims. Empathy and patience are also important when dealing with patients who may be stressed or confused about their medical bills.
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Use of Basic Office Equipment: Beyond computers, familiarity with standard office equipment is expected. This includes proficiency with 10-key calculators, printers, copiers, scanners, and phone systems. Basic office skills contribute to overall efficiency in the role.
Medical Coding Certification
While not universally mandated, professional certification significantly enhances job prospects in medical billing and coding. Earning an industry-recognized credential, such as the Certified Professional Coder (CPC®) from the AAPC (American Academy of Professional Coders), demonstrates competency and commitment to the profession.
The CPC certification requires passing a rigorous exam and meeting experience or educational prerequisites. For those who pass the CPC exam but lack sufficient experience, the CPC Apprentice (CPC-A) designation is available. CPC-A status can be upgraded to full CPC certification upon completing two years of on-the-job experience or a combination of relevant coursework and experience. Certification not only validates skills but can also lead to higher earning potential and career advancement opportunities.
Medical Billing and Coding Wages
The BLS reports the median annual salary for medical secretaries, a category that includes medical billers and coders, was $37,450 per year in May 2021. This median figure indicates that half of the professionals in this field earned more than this amount, and half earned less.
The top 10% of earners in this field could reach over $63,100 annually, likely representing those with extensive experience and potentially advanced roles. Entry-level positions, represented by the lowest 10% of earners, averaged around $29,040 per year or $13.96 per hour in May 2021. UMA (Ultimate Medical Academy) graduates from the 2021-2022 cohort of medical billing and coding programs reported median hourly wages at or slightly above this entry-level decile. [^1]
As you gain experience and expertise in medical billing and coding, your earning potential typically increases. Advancement to senior-level roles or supervisory positions can also lead to higher salaries.
Who Is a Good Fit for a Medical Billing and Coding Career?
Success in a medical billing and coding career hinges on strong organizational skills and meticulous attention to detail. If you are a detail-oriented individual who excels at time management and can effectively handle multiple tasks simultaneously, this career path may be well-suited for you.
Ideal candidates are comfortable working in an office environment, as the role involves considerable time spent in front of a computer and managing patient records. A natural aptitude for medical terminology, or a strong willingness to learn it, is also beneficial. Furthermore, the field requires continuous learning to stay abreast of evolving coding guidelines and procedures, so a commitment to ongoing professional development is essential.
If this description resonates with you, pursuing training for a medical billing and coding specialist position could be a rewarding career move.
Getting Started in Medical Billing and Coding
While some entry-level medical billing and coding positions might be available without formal training, most employers prefer candidates with relevant experience or professional certification, and often both. Earning a diploma or degree in medical billing and coding is a significant advantage, providing you with the necessary knowledge and skills while also preparing you for certification exams.
Are you ready to capitalize on the promising growth in the medical billing and coding industry?
Ultimate Medical Academy offers online diploma and degree programs in medical billing and coding to help you launch your career. UMA’s programs provide comprehensive training and prepare you to sit for the CPC certification exam upon meeting eligibility requirements.
Upon successfully passing the exam, you can achieve the CPC-A designation and progress to full CPC status as you gain experience.
Take the first step towards becoming a medical billing and coding specialist. Contact us today to learn more about our online programs and how they can help you achieve your career goals.
[^1]: UMA’s 2021-2022 graduate earnings estimate is based on wage information obtained for UMA graduates from the cohort. Earnings information was typically obtained by a self-report from the graduate, and occasionally from the graduate’s employer or other sources.
