What Can You Do With a Medical Billing and Coding Certificate?
As the strain on the healthcare system continues, the demand for trained medical professionals remains high. Along with doctors and nurses, the industry seeks support workers to fill a variety of positions.
Many individuals work behind the scenes to ensure that the healthcare system runs smoothly. Medical billers and coders provide patients and physicians alike with crucial services.
Read on to learn what medical billers and coders do and which credentials they need to succeed in the job market.
Medical Billing and Medical Coding Certificate Programs
While medical billers and medical coders earn different certifications, many programs combine both into one curriculum. Individuals who complete a medical billing and/or medical coding program can choose from a variety of certifications that reflect their work setting and responsibilities.
Medical Billing Curriculum
There are many online programs that help prospective medical billers prepare for certification exams. Commonly offered courses address:
- Medical terminology
- Health information management
- Medical billing technology
- Electronic medical records
- Anatomy and physiology
- Law, liability, and ethics
Medical Billing Certification
Prospective medical billers can pursue multiple certifications, including:
Certified Professional Biller (CPB): The CPB exam covers types of insurance, billing regulations, HIPAA, and reimbursement and collection protocols. Test-takers must understand industry rules and regulations and how to process medical billing claims.
The American Academy of Professional Coders (AAPC) offers this credential, which qualifies candidates to work as billers in almost any medical setting.
Certified Medical Reimbursement Specialist (CMRS): The CMRS exam comprises 694 questions divided into 16 sections. Test-takers receive 45 days to complete the open book exam. The CMRS credential allows billers to facilitate the entire claims process, which ends once a patient pays their balance in full.
The American Medical Billing Association’s certifying board administers this credential. While the certification is not required for employment, it highlights the holder’s competency and proficiency.
- Certified Medical Billing Specialist (CMBS): The CMBS certification is intended for individuals who work at a provider’s office, health insurance company, or independent billing center.
Medical Coding Curriculum
The AAPC offers an online program to help candidates prepare for certification exams. The program surveys the following subjects:
- The business of medicine
- International classification of diseases
- Anatomy and physiology
- Integumentary, musculoskeletal, cardiovascular, digestive, reproductive, endocrine, nervous, and auditory systems
- Anesthesia, radiology, and pathology
- Evaluation and management
Medical Coding Certification
Medical coding certifications let recipients focus on certain settings and specializations. These credentials include:
Certified Personal Coder (CPC): The CPC exam contains multiple choice questions that present various coding scenarios. Administered through the AAPC, the exam can be completed online or in person.
Those who earn their CPC certification can work in almost any medical setting that uses general practice coding, from large hospitals to private practices.
Certified Outpatient Coder (COC): Questions on the COC exam pertain to current procedural terminology, procedure and supply codes, and diagnosis codes used for coding and billing outpatient services to insurance companies. The certification is issued through the American Medical Association.
Most coders with a COC certification work at outpatient facilities, in ambulatory surgical centers, or billing and coding departments.
Certified Inpatient Coder (CIC): The AAPC issues this certification. The exam itself focuses on the test-taker’s understanding of coding for acute care facilities and outpatient and inpatient reimbursement concepts. Coders with this credential are knowledgeable in medicare severity diagnosis related groups and inpatient prospective payment systems.
Individuals with a CIC certification can work in any type of inpatient hospital or medical facility.
Certified Risk Adjustment Coder (CRC): This exam tests coders’ knowledge of diagnosis codes used in clinical cases, the chronic illness and disability payment system, and the U.S. Department of Health and Human Services’ risk adjustment program.
Individuals with the CRC credential often work in physicians’ offices or inpatient facilities.
What Does a Medical Billing and Coding Specialist Do?
Similar to medical and coding academic programs, companies tend to combine both specializations into one category. Both specialists organize, manage, and code patient information for use by medical facilities and insurance companies.
While billers and coders can take on specific positions, such as medical information clerk and medical records analysts, many of their responsibilities overlap. Both roles typically include the following responsibilities:
Medical Billing
- Submit and follow up on claims with insurance companies regarding payment for medical services
- Read and comprehend medical records
- Translate healthcare services into billing claims
- Verify healthcare coverage and collect copays
- Secure insurance authorizations
Medical Coding
- Translate medical documentation into standardized codes for use at medical facilities and insurance companies
- Receive and review patients’ charts for completeness and accuracy
- Collect information from medical professionals to prepare various reports
- Create and execute procedures regarding evaluation methods to confirm accuracy
- Train healthcare professionals and staff on how to correctly use medical codes
According to the Bureau of Labor Statistics (BLS), medical records and health information specialists earn a median annual salary of $50,250. The job outlook for both positions also appears positive, with a projected job growth rate of 7% from 2024-2034.
Where Do They Work?
Medical billers and coders work in many settings. According to BLS data, the largest employers include:
28%
Hospitals (State, Local, & Private)
19%
Physician’s Offices
8%
Management of Companies & Enterprises
8%
Administrative & Support Services
7%
Professional, Scientific, & Technical Services
The AAPC finds that medical billers and coders most often work in the following settings:
- Health systems
- Inpatient hospitals
- Outpatient hospitals
- Solo/small group practices
- Medium group practices
- Large group practices
Frequently Asked Questions About Medical Billing and Coding
Medical coders must usually hold a high school diploma or GED, although there is no formal education requirement needed to become a coder. Most employers seek candidates with a medical coding certificate. Certification programs take approximately 9-12 months to complete.
