Medical billing and coding is emerging as one of the fastest-growing occupations in the United States. Falling under the broader category of medical secretaries by the U.S. Bureau of Labor Statistics (BLS), this field is projected to see an impressive 8% increase in employment between 2021 and 2031, translating to roughly 53,600 new job opportunities. This surge in demand is largely fueled by an aging population requiring increased healthcare services.
Every healthcare provider, from hospitals to private practices, relies on efficient medical billing and coding to manage insurance claims and patient invoices. While in smaller settings, doctors or office managers might juggle these responsibilities alongside their primary duties, larger facilities often require dedicated staff specializing in these areas. Given that clinical staff are primarily focused on patient care, the crucial administrative tasks of billing and coding are typically entrusted to trained specialists. This ensures healthcare providers receive proper reimbursement for their services.
Does a career as a billing and coding specialist pique your interest? Let’s delve into the essential aspects of thriving in this rapidly expanding industry and determine if this career path is called for you.
What is a Medical Billing and Coding Specialist?
A medical billing and coding specialist acts as a vital link between healthcare facilities and insurance providers. In essence, they are the professionals who ensure healthcare providers are accurately and efficiently compensated for the medical services they deliver.
But what does this role entail on a daily basis?
The core responsibilities of a medical coding and billing specialist revolve around managing the financial interactions between healthcare providers, patients, and insurance companies. Their daily tasks commonly include:
- Accurately translating medical services, procedures, diagnoses, and treatments into standardized codes.
- Preparing and submitting invoices or claims to insurance companies for payment processing.
- Addressing and rectifying rejected claims to ensure successful reimbursement.
- Systematically tracking payments from insurance providers and patients.
- Proactively following up with patients and insurance companies regarding outstanding balances.
While these specialists are integral to the operations of healthcare facilities, their work is predominantly office-based, involving minimal direct patient interaction. A significant portion of their workday is spent working at a computer, meticulously reviewing, inputting, and updating crucial medical and financial information.
Billing vs. Coding: Understanding the Key Differences
Although the terms “medical billing” and “medical coding” are frequently used together and often combined into a single job description, they represent two distinct yet interconnected functions within the healthcare revenue cycle. Each role carries its own specific responsibilities and tasks.
Many smaller healthcare practices opt to hire individuals proficient in both billing and coding to streamline operations. Conversely, larger healthcare organizations might delineate these roles into separate positions to foster specialization. Therefore, understanding the nuances between these two roles is crucial for anyone considering a career in this field.
What Does a Medical Coder Do?
Medical coding is the process of transforming a healthcare provider’s detailed clinical notes, encompassing diagnoses and procedures, into a standardized set of alphanumeric codes. These codes are universally recognized within the healthcare industry and are used for a multitude of purposes, including accurate record-keeping, efficient data analysis, and, crucially, medical billing. Proficiency in medical coding necessitates a comprehensive understanding of the various coding systems, primarily:
- ICD-10-CM: International Classification of Diseases, Tenth Revision, Clinical Modification, used for diagnosis coding.
- CPT: Current Procedural Terminology, used for medical, surgical, and diagnostic procedures and services.
- HCPCS Level II: Healthcare Common Procedure Coding System, primarily used to identify products, supplies, and services not included in CPT codes, such as ambulance services and durable medical equipment.
Medical coders must adhere to strict coding guidelines to ensure accuracy and compliance when assigning codes for insurance billing and healthcare records.
The coding process can initiate as early as when a patient schedules an appointment. Initial codes may be assigned to categorize the type of visit and the patient’s presenting symptoms. Subsequently, as the patient receives care, further codes are added to document observed symptoms, diagnostic tests performed, procedures administered, confirmed diagnoses, and prescribed treatments.
What Does a Medical Biller Do?
Following the completion of the medical coding process, medical billing specialists take over to generate invoices and submit claims to patients’ insurance providers or other responsible payers. Insurance companies then evaluate these claims, using the provided codes to determine whether to approve or deny payment. Any remaining balance not covered by insurance becomes the patient’s responsibility.
The billing cycle often commences at the point of patient appointment scheduling. Codes can be entered and submitted to insurers for pre-authorization, allowing the healthcare facility to inform the patient of their estimated out-of-pocket expenses prior to the visit and collect that amount upfront.
A medical biller must possess a working knowledge of medical codes, even if coding is performed by a separate individual. This understanding is essential for reviewing denied insurance claims, identifying coding errors, and making necessary corrections before resubmitting claims for reconsideration. Medical billers also play a critical role in proactively verifying code accuracy prior to initial claim submission.
Beyond insurance billing, medical billers are responsible for invoicing patients for any outstanding balances after insurance processing. Their duties also include verifying patient co-pay requirements, meticulously tracking payments received, and diligently following up on overdue payments from both insurance companies and patients.
In cases of unpaid bills, the billing specialist is tasked with communicating with insurance companies to resolve any claim discrepancies and ensure proper documentation. If patient payments remain outstanding beyond a specified period and follow-up attempts are unsuccessful, the billing specialist may initiate debt collection procedures by referring the account to a collection agency.
Combining Medical Billing and Coding
The inherent interconnectedness of medical billing and coding processes has led many healthcare facilities to seek professionals proficient in both disciplines. Hiring billing and coding specialists capable of performing both roles offers operational efficiency and streamlined workflows. While larger healthcare institutions may employ separate billing and coding teams, these teams invariably collaborate closely to guarantee accuracy and efficiency throughout the revenue cycle. The paramount objective is to minimize billing and coding errors, thereby ensuring timely and accurate payment collection.
Other Requirements
While specific job titles and descriptions for medical billing and coding careers can vary across employers, the fundamental requirements tend to remain consistent. A strong grasp of medical codes is a primary prerequisite, but a broader skill set enhances employability and success in this field.
-
Medical Terminology: A foundational understanding of medical terminology is indispensable for accurate coding. This encompasses knowledge of anatomy, physiology, diagnostic terms, and procedural terminology. Familiarity with commonly used medical terms facilitates efficient and precise billing and coding processes.
-
Basic Math Skills: Proficiency in basic arithmetic is necessary for calculating billing amounts. While billing software automates many calculations, billers may need to manually determine patient balances, calculate payment plan installments, and reconcile financial records.
-
Computer Skills: The modern medical billing and coding landscape is heavily reliant on computer systems and specialized medical software. Comfort and competence in using computers, coupled with the ability to quickly learn new software applications, are highly valued.
-
Communication Skills: Effective communication is crucial, particularly for medical billers who frequently interact with patients regarding payments. The ability to communicate clearly, professionally, and empathetically is essential when addressing patient inquiries and resolving billing concerns. Patients may be experiencing stress or anxiety related to their health and medical expenses, so strong communication skills can help navigate these interactions with sensitivity.
-
Use of Basic Office Equipment: Beyond computer proficiency, familiarity with standard office equipment is expected. This includes operating 10-key calculators, printers, copiers, scanners, phone systems, and other common office tools. Prior experience in an office environment is often beneficial.
Medical Coding Certification
While not universally mandated by all employers, obtaining industry certification, such as the Certified Professional Coder (CPC®) credential offered by the AAPC (American Academy of Professional Coders), can significantly enhance a candidate’s appeal in the competitive job market. Certification demonstrates a commitment to professional excellence and validated competency in coding practices.
Although full CPC certification entails specific work experience and eligibility criteria, individuals who successfully pass the CPC certification exam but lack the required experience may be granted the CPC Apprentice (CPC-A) designation. CPC-A status can be elevated to full CPC certification upon providing proof of two years of relevant on-the-job experience or completion of 80 contact hours in a coding preparation course combined with one year of practical experience.
Medical Billing and Coding Wages
According to the BLS, the median annual salary for medical secretaries, a category encompassing medical billers and coders, was $37,450 in May 2021. This indicates that half of medical billing and coding specialists earned above this figure, and half earned below.
The top 10% of earners in this field reached salaries exceeding $63,100, potentially reflecting those in senior or supervisory roles with extensive experience. Conversely, the lowest 10% of earners reported average earnings of $29,040 annually or $13.96 per hour, which may be representative of entry-level positions or professionals with limited experience. UMA (Ultimate Medical Academy) graduates from the 2021-2022 medical billing and coding programs reported median hourly wages approximating or slightly surpassing the BLS’s lowest decile.
Career advancement and increased earning potential are common with accumulating experience in the field, particularly when progressing into senior-level or supervisory positions.
Is a Medical Billing and Coding Career Right for You?
Success as a medical billing and coding specialist 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 manage multiple tasks concurrently, a career in medical billing and coding may be an excellent fit.
Ideal candidates are comfortable working in an office environment, as the role involves extended periods spent in front of a computer and handling patient records. A solid understanding of medical terminology, or a strong willingness to learn it, is essential. Furthermore, given the ever-evolving nature of healthcare regulations and coding guidelines, a commitment to continuous learning and professional development is a valuable attribute for individuals in this field.
If this profile resonates with your skills and interests, pursuing training for a medical billing and coding specialist position could be a rewarding career path.
Getting Started: Your Path to a Billing and Coding Career
Entry-level billing and coding positions may be accessible to individuals without formal training or prior experience. However, many healthcare employers prefer candidates with formal education or professional certification, and often a combination of both. Enrolling in a diploma or degree program in medical billing and coding provides the necessary foundational knowledge and prepares students for certification exams.
Are you looking to capitalize on the promising growth trajectory of the medical billing and coding industry?
You can embark on your journey by exploring online diploma or degree programs in medical billing and coding offered by institutions like Ultimate Medical Academy. A UMA education not only culminates in a valuable credential but also equips you with the necessary competencies to pursue CPC certification upon meeting eligibility requirements.
Upon successfully passing the certification exam, you can attain the CPC-A designation, which can be upgraded to full CPC status as you gain practical experience and meet the eligibility criteria.
Are you ready to take the first step towards becoming a medical billing and coding specialist? Contact us today to discover more about our comprehensive online diploma and degree programs.
[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.
