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If you've ever wondered about the day-to-day duties of a medical billing and coder, look no further. As an administrative expert, these professionals play a critical role in the healthcare industry. In this comprehensive guide, we'll explore the ins and outs of this career path. From the necessary skills and education to the job responsibilities, we've got you covered. Join us as we dive deep into the world of medical billing and coding, and discover how you can become a part of this essential field.
What Is Medical Billing and Coding?
A medical biller is a professional who is responsible for translating and transcribing medical information from doctors and other healthcare providers into a specific set of codes that can be used by insurance companies, government agencies, and other organizations to determine reimbursement for services provided.
They also must submit and track insurance claims with private health insurance companies, and other establishments like Medicaid, and Medicare. That way, they can input patient information and other necessary documents in order to determine whether insurance will cover their care.
Medical Billing Job Responsibilities
A medical biller is responsible for a number of duties. This includes submitting and tracking claims with healthcare insurance companies and other entities such as Medicaid and Medicare. A medical biller does this by entering patient demographic information, coding diagnoses and procedures, submitting claims, and verifying a patient's eligibility for insurance.
A medical biller is also responsible for creating and sending invoices to patients, investigating denied claims, and communicating often with patients and insurance companies.
Medical Coding Job Responsibilities
Medical coders wear many hats, and their responsibilities vary greatly. A medical coder does not write code for computer programming, even if their name may suggest it. Instead, a medical coder is responsible for transforming healthcare information into short numeric or alphanumeric codes which are used to document patients' diagnoses and procedures. This information is then used to bill the patient and their insurer.
What Is a Medical Billing and Coding Specialist?
In some cases, a medical biller and coder can be combined into one role where the professional is responsible for both billing and coding. This role is often referred to as a medical biller and coder or a medical billing and coding specialist.
What's the difference between a medical biller and a medical coder?
The main difference between a medical biller and a medical coder lies in each position's primary focus. A medical biller focuses on the financial side of healthcare, while a medical coder specializes in coding health information for the purpose of reimbursement. These two positions work in tandem to benefit the hospital or medical center as a business.
What’s the Difference Between a Medical Biller and a Medical Coder?
A medical billing and coding specialist wears many hats, and their responsibilities cover a wide range of tasks. Some tasks are secretarial while others require that you receive proper training and certification in order to complete them.
Entering patient information
The medical biller and coder must enter the patient's information into the medical records system accurately and in a timely manner. That way, the patient's insurance company can move forward and the patient's medical record stays up-to-date and accurate.
Coding diagnoses and procedures
A medical coder must be knowledgeable of medical coding systems in order to correctly assign the right codes to diagnoses and procedures. Proper training is required in order to perform coding duties.
Submitting claims to insurance companies
The medical biller must submit claims to insurance companies in a timely and accurate manner. They also must stay up-to-date on insurance company regulations. Honestly, a medical biller must be an expert on all things "insurance," in order to answer questions and provide clarification to patients and medical professionals as needed.
Resolving claims denials
The medical billing and coder must be able to identify and resolve any issues that lead to a denied claim. This takes continuous education, and a medical billing and coder must stay up-to-date on current insurance information and regulations.
Additional responsibilities
A medical billing and coding specialist will also be expected to do the following tasks:
- Assign patients to diagnosis-related groups (DRGs)
- Determine solutions for issues when codes have missing or unclear information by consulting the appropriate professionals
- Organize a patient's medical records so treatment can be documented along with the data needed to control costs for care
- Handle all government forms, business documents and patient admission and discharge forms
- Code patient data by using the standard classification systems
- Ensure complete confidentiality with medical records for all patients
- Schedule patient appointments as needed
- Obtain patient medical records from medical personnel
- Review patients' medical records for accuracy and scan them into electronic formats
- Continue to learn about disease processes in order to do their jobs effectively
- Use several health record systems in order to organize them and store them properly
- Transcribe medical reports from physicians and other medical personnel
- Input patient data, including demographic information and medical history
- Post billings for medical insurance and send it to the appropriate agencies
What Kind of Skills Do Medical Billers and Coders Need?
Medical billing and coding professionals need to have a number of skills and abilities in their toolboxes in order to be successful. Some of them include:
Knowledge of medical terminology
Medical billers and coders must have a strong understanding of medical terminology in order to properly code diagnoses and procedures. They will use this task every day to input information and to pull medical diagnoses and treatment plans from patient medical records.
Knowledge of coding systems
Medical billers and coders must be familiar with ICD-10, CPT, and HCPCS coding systems.
Computer skills
Excellent computer skills are required, since a medical biller and coder will need to work with a variety of medical records systems and software.
Attention to detail
It is essential that medical billers and coders are detail-oriented in order to accurately enter patient information and assign codes. Small mistakes can mean big problems, and lost funds for the medical center or the patient.
Ability to multitask
Medical billers and coders must be able to prioritize tasks and manage their workload in order to stay on top of their duties. This position encompasses a number of tasks that need to be completed efficiently and on time.
Basic math skills
Medical billing and coding specialists must be able to calculate payments and reimbursements accurately. Most individuals in this position use a calculator to help with quick calculations.
Excellent communication skills
Medical billers and coders must be able to clearly and effectively communicate with patients, doctors and insurance companies in order to resolve problems and get clarification on a patients' medical record, insurance information and treatment plan.
Ability to use office equipment
Medical billers and coders must be able to use office equipment, including computers, printers, fax machines and calculators.
Education requirements
The minimum educational requirement for a medical billing and coding professional is a high school diploma or equivalent. However, many organizations are looking for candidates with an associate's degree from an accredited institution.
Certification requirements
Many employers require medical billers and coders to be certified by either AHIMA (American Health Information Management Association) or AAPC (American Academy of Professional Coders). Both organizations offer comprehensive certification programs that test an individual's knowledge of medical terminology, anatomy and physiology, coding systems, and healthcare reimbursement procedures. Once you complete the certification process, you can take an exam in order to become AHIMA or AAPC certified as a medical billing and coding specialist.
What kind of jobs are available for medical billers and coders?
Medical billers and coders can find jobs in a variety of settings. Some of them include:
- Hospitals
- Physician offices
- Mental health facilities
- Nursing homes
- Insurance companies
- Government agencies
Salary and job outlook
According to the Bureau of Labor Statistics, the median salary for medical billers and coders is around $46,660, or just over $23 an hour. The job outlook for this profession is also strong, with an expected growth of 7% through 2031.
If you're looking for a career that's challenging and rock solid, consider becoming a medical biller and coder.
What type of person is a good fit as a medical billing and coder?
A medical billing and coding specialist should be a detail-oriented individual who is comfortable working with numbers and technology. A good candidate for medical billing and coding is someone who is academically gifted, is interested in medical science, and enjoys learning new things.
It is also important to have excellent communication and customer service skills, as you will be interacting with medical staff, insurance companies, and patients on a regular basis.
Bottom Line
Medical billers and coders are essential to the healthcare system, as they ensure that healthcare providers are paid for the services they provide. While the job requires knowledge of medical terminology, coding systems, and computer skills, it is rewarding for those who are interested in impacting healthcare in an administrative capacity. If you think this could be the right career for you, start by obtaining your high school diploma or equivalent and gaining experience by interning or volunteering at a healthcare facility.