Medical Billing and Coding Specialist

Work Settings

• •Hospitals (inpatient and outpatient departments)
• •Physician offices and clinics
• •Third-party billing companies (RCM vendors)
• •Remote/work-from-home
• •Insurance companies
• •Ambulatory surgery centers

Primary Duties

• •Review clinical documentation and assign accurate ICD-10-CM, CPT, and HCPCS Level II codes
• •Capture all billable charges for services, procedures, and supplies provided to patients
• •Scrub claims for errors and compliance issues before submission to insurance payers
• •Investigate denied claims, identify root causes, and submit corrective appeals
• •Post payments from insurance companies and patients, reconciling discrepancies
• •Conduct internal audits to ensure coding accuracy and regulatory compliance
• •Assign appropriate Evaluation and Management (E/M) code levels based on visit complexity
• •Stay current with annual coding updates, payer policy changes, and federal regulations

How to Become Medical Billing and Coding Specialist

Continuing Education

Maintaining your certification requires ongoing continuing education units (CEUs). AAPC requires 36 CEUs every two years to maintain CPC certification, while AHIMA requires 20 CEUs every two years for CCA. You'll earn these through webinars, workshops, conferences, and self-study courses covering coding updates, regulatory changes, and new healthcare technologies. Annual updates to CPT and ICD-10-CM code sets require continuous learning to stay current. Many employers provide or reimburse continuing education opportunities, recognizing that your knowledge directly impacts their revenue cycle performance and compliance.

Certifications & Licenses

• •Certified Professional Coder (CPC) - AAPC (entry-level, outpatient focus)
• •Certified Coding Associate (CCA) - AHIMA (entry-level, all settings)
• •Certified Professional Biller (CPB) - AAPC (billing specialization)
• •Certified Coding Specialist (CCS) - AHIMA (advanced, inpatient focus)
• •Certified Outpatient Coder (COC) - AAPC (outpatient facility coding)
• •Certified Inpatient Coder (CIC) - AAPC (inpatient hospital coding)
• •Certified Risk Adjustment Coder (CRC) - AAPC (risk adjustment specialization)
• •Certified Billing and Coding Specialist (CBCS) - NHA (entry-level)

Citations

• BLS Occupational Outlook Handbook - Medical Records Specialists ↗
• American Academy of Professional Coders (AAPC) ↗
• American Health Information Management Association (AHIMA) ↗
• Commission on Accreditation for Health Informatics and Information Management Education (CAHIIM) ↗
• Centers for Medicare & Medicaid Services (CMS) ↗

Similar Careers