How to Become an RN Coder

Are you interested in a career change? Do you want to stop working nights, weekends, and holidays? Making the transition from clinical nurse to RN medical coder may help balance your work and life.

Registered nurses (RN)s are vital to the healthcare system. They can lend their experience and knowledge to the billing process to help keep accurate records and prevent insurance fraud.

Discover how this job opportunity may fit your lifestyle.

An RN coder applies medical coding and reimbursement policies in the claims process. Nurse coders review patient charts and provide diagnosis codes based on International Classification of Diseases (ICD) or Current Procedural Terminology guidelines.

They also help create and carry out cost strategies that ensure healthcare providers’ success. Nurse coders may work in hospitals, offices, clinics, or insurance companies. Some RN coders work remotely at home.

A nurse coder works closely with medical billing specialists to identify errors and achieve team goals. For example, RN coders may audit the work of other coders for accuracy. (This differs from a clinical documentation specialist, who reviews a patient chart for potential errors before being discharged.)

RNs’ familiarity with medical terminology, anatomy, and physiology, and their clinical experience can aid the transition to nurse coding.

Nurse coders must review patient charts, procedure notes, medication reconciliations, and labs to assign the correct ICD and CP codes. Many of these codes have dual meanings and slight differentiations that may be easier to distinguish with clinical experience.

Nurses can add coding to their knowledge and skills in a matter of weeks by attending a medical coding bootcamp or webinar. Earning coder certification can lead to more job opportunities and higher salaries.

The path to a billing and medical coder career does not always begin with a nursing degree. However, those who have a nursing degree are in high demand. They have the education and skills to read medical records and choose the right diagnostic codes for billing. Additional education and requirements can vary among states and employers.

Nurses can enter the nursing field with a two- or four-year degree. While either is acceptable, a four-year degree offers more flexibility, opportunities for advancement, and greater RN coder salary potential.

RNs are highly sought after in the medical billing and coding profession.

Maintaining an RN license and earning coder certification demonstrates commitment. It also helps protect an employer’s compliance with insurance companies and agencies like the Centers for Medicare & Medicaid Services.

An RN license requires at least an ADN and a passing score on the NCLEX-RN. Employers, particularly in the nurse coding field, may prefer applicants who hold BSNs. Both an ADN or BSN provides eligibility for the NCLEX-RN.

Licensed RNs with ADNs can enroll in RN-to-BSN bridge programs to earn their nursing bachelor’s degrees sooner.

Becoming certified entails taking the CPC or CCA exam. Both CPC and CCA credential holders qualify for entry-level coding positions.

To get a nursing license, candidates must master NCLEX-type test questions and pass the NCLEX-RN. This proves a job candidate has the competency to practice as a new nurse. The NCLEX-RN covers subjects learned in nursing school.

Nurses graduating from an accredited program are eligible to take the exam. Before registering for the exam, graduates must get an authorization to test and pay the required fee.

Each state may have additional eligibility requirements, so it is important to check with the state’s nursing regulatory body.

The AAPC does not have any eligibility requirements to take the CPC exam, but applicants must be an AAPC member. Student membership is $140 and individual membership is $205.

The test is 100 multiple-choice questions and takes four hours. Exam locations are across the U.S. Certification is not official until two years of medical coding experience are completed.

Offered by the American Health Information Management Association (AHIMA), Certified Coding Associate (CCA) certification requires a high school diploma. The AHIMA recommends, but does not require, either six months of coding experience or coding program completion.

The computer-formatted exam consists of 90-115 questions to be completed in two hours. Joining the AHIMA is optional, but non-members pay a $299 exam fee, while members pay $199.

AHIMA annual membership costs $49 for students, $149 for professionals, and $209 for the premier level.

RN coders often seek additional certifications in specialty areas. For example, the Certified Risk Adjustment Coder Examination focuses on codes in risk adjustment. Risk adjustment is important in patient populations where there is a greater burden of disease.

A certified professional medical auditor can be critical for a healthcare system’s revenue cycles. This certification allows nurse coders to audit medical documentation for fraud and abuse.

It’s helpful to have at least two years of experience as an RN coder before taking the CPC examination. AAPC grants full certification to those who pass the exam and can submit proof of experience. Full certification improves job options and salary potential.

Hospitals, doctors’ offices, and medical coding companies advertise on job boards and job fairs for RN coders. Potential nurse coders can raise their job appeal by completing a medical coding course before certification.

The average annual salary for an RN coder is $57,182, according to ZipRecruiter data as of April 2024. This falls below the average annual salary of RNs ($82,750) according to the U.S. Bureau of Labor Statistics (BLS).

Additional certifications can increase job prospects. RN coders can find employment in several different settings:

Candidates who hold a BSN degree may complete AAPC’s online course in six months. This can help potential nurse coders get their first coding job. After two years of experience, candidates may take the CPC exam.

After completing an online or in-person medical coding training program, aspiring nurse coders can gain experience through job shadowing and internships. AAPC membership has networking access to RN coders across the country. Networking is a great way to find internships, job openings, or volunteer positions.

Those who pass the CPC exam without two years of experience can take part in the apprentice program which can also be an advantage for job seekers.

RN coders have a strong attention to detail and high communication skills. These skills can help nurse coders perform research for coding and billing systems and work with healthcare professionals. RN coders should be able to work independently as many companies are moving to remote work. This means a nurse coder must be able to adapt to new technology and challenges.

The CPC certification is the standard one that demonstrates competency to employers. Additional certifications can boost employability and salary potential. These include outpatient, inpatient, and risk adjustment coding. AAPC also has certifications for specialty areas like dermatology, cardiology, gastroenterology, and orthopedic surgery.

Page last reviewed December 19, 2022