How to Become a Medical Biller or Coder
Is a career in medical billing and coding right for you? Learn about this rapidly growing field, education and certification requirements, and potential salary.
Medical billing and coding careers can offer rewarding healthcare employment without spending the time and money on a medical or nursing degree. These professionals handle payments for healthcare providers, insurance companies, and patients. The need for medical billers and coders has increased with the rise in healthcare services.
Unique medical codes tell what the provider charges for services. Coders update medical records and claims with the right codes that describe patients' treatments and services.
Medical billers use these codes to create and submit claims to patients, insurance companies, and other payers.
This guide explores how to enter a career in medical billing and coding, including education requirements, certification pathways, and salary prospects.
What Is a Medical Biller?
While often one person does medical billing and coding, they are two jobs with different skill sets. Medical billers and coders do not provide patient care, but billers are more likely to work with patients. Billers must have good communication skills to discuss medical charges with patients, healthcare providers, and insurance carriers.
A medical biller uses special software to input medical codes and file claims with insurance companies or government agencies such as Medicare. The biller also submits a statement to the patient for any amount not covered by insurance. A medical biller may also:
- Verify insurance coverage, pre-authorizations, and referrals
- Correct statements and payments
- Set up payment plans and collect on past due accounts
- Appeal denied insurance claims
- Be knowledgeable in HMO/PPO, Medicare, and Medicaid coverage
The U.S. Bureau of Labor Statistics (BLS) projects these healthcare professionals to grow by 9% between 2020 and 2030. The expected increase reflects the growing demand for healthcare by older adults and the expansion of insurance coverage among all age groups.
According to the American Association of Professional Coders (AAPC), a medical biller earns an average annual salary of $61,000, but earnings vary with setting, education level, certifications, and experience.
What Is a Medical Coder?
Medical coders assign codes to medical terms. These terms can refer to treatments, procedures, equipment, and services. Medical coders enter these codes into billing systems. With these codes, healthcare providers can receive correct payments through insurance or directly from patients.
Medical coders help keep billing and payments accurate and in line with regulations. Although coders usually work independently, they must communicate well with medical billers, physicians and nurses, and administrative staff.
Because medical coders work in many different healthcare settings, their day-to-day tasks may vary. However, common responsibilities include:
- Analyzing patient records and clinical reports
- Researching reimbursement and payment information
- Translating medical information into codes for billing
- Maintaining federal and state compliance
- Performing audits for accuracy
Like medical billers, coders can expect an expanding job market through the end of the decade. AAPC reports that coders make an average yearly salary of $54,890, but they can earn much more with certifications. Earnings also vary by specializations, educational level, and experience.
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Steps to Becoming a Medical Biller or Coder
Earn a high school diploma (or equivalent).
An individual can pursue an entry-level job in medical billing and coding with a high school diploma or GED certificate. However, certification and advanced training can boost career options and earning potential. Certificate/diploma programs and associate degrees require a high school diploma or its equivalent for admission.
Enroll in medical billing and/or coding programs.
Diploma programs and associate degrees are the most common educational pathways for medical billing and coding careers. Aspiring professionals can enroll at vocational and technical schools.
These programs take a year or less to complete. They provide the training for national coding certification exams and entry-level positions. Many schools offer medical billing and coding classes online.
Employers typically prefer to hire associate degree-holders, which can take two years. An associate degree offers a foundation in general education with a focus in medical terminology, coding, and information technology (IT).
Associate-level graduates can find career opportunities in insurance companies, government, and healthcare providers. Students often transfer their associate degree credits to bachelor's programs.
Pass certification examinations.
Healthcare employers generally prefer billers and coders who have earned professional certifications. These certifications ensure mastery of complex billing and government-mandated coding requirements.
Certification can lead to more job opportunities and higher salaries.
Many schools that offer medical billing and coding training offer career services. The career office can help learners prepare resumes, practice interview skills, and find job openings.
Job candidates should include any internships and relevant work experience in their applications. Individuals can read AAPC's information on the cities and states that have the best job opportunities and highest salaries.
Medical Billing and Coding Certification
Diploma programs and associate degrees prepare students to enter this field and for professional certification exams. Most students pursue either the certified professional biller (CPB) or the certified professional coder (CPC) credentials.
While these are separate credentials, many programs offer dual certifications as CPBs and CPCs.
Medical Billing Curriculum
Medical billing and coding programs offer similar courses in medical terminology, medical ethics and law, and anatomy and physiology. Medical billing coursework also includes:
- Healthcare communications
- Records management
- Computer applications for billing
- Health insurance and reimbursement
Medical Billing Certification
Medical billers do not need professional certification to find employment, but it can increase job and salary options.
- Certified Professional Biller: The CPB credential from AAPC is the most recognized billing certification. This certification verifies that medical billers have mastered the skills to maintain healthcare providers' revenue cycles. The CPB exam includes 200 multiple-choice questions focusing on billing practices, managed care, Medicare and Medicaid, and HIPAA compliance.
- Certified Billing and Coding Specialist: The CBCS certification, administered through the National Healthcareer Association, concentrates on medical billing and coding for insurance claims. The 100-question exam covers the revenue cycle, compliance, insurance eligibility, coding guidelines, and reimbursement.
Medical Coding Curriculum
Most coding programs train in medical terminology, coding classifications, HIPAA compliance, and Medicare and Medicaid policies. While each school has specific course requirements, medical coding students typically take classes in:
- Diagnostic and procedural coding
- Billing and coding applications
- International diseases classification
- Current terminology coding
Medical Coding Certification
AAPC and the American Health Information Management Association (AHIMA) offer some of the most commonly recognized medical coding certifications, including:
- Certified Professional Coder: AAPC administers the popular CPC credential. This certification indicates mastery of all standard code sets and guideline and management principles. The multiple-choice exam covers 17 areas such as the proper procedure to supply diagnosis codes used by healthcare providers.
- Certified Coding Assistant: The CCA certification from AHIMA outlines six domains: clinical classical systems, reimbursement methodologies, health records and data content, compliance, IT, and confidentiality and privacy.
- Certified Coding Specialist: This AHIMA certification points to mastery in coding skills and documentation, provider questions, and compliance. The CCS exam includes multiple-choice questions and a medical scenario section.
Medical coders may pursue even more specialized certifications from AAPC: auditing, documentation, risk adjustment, and physician practice management. Experienced coders can get certifications in specific medical disciplines such as anesthesiology and pain management, orthopedic surgery, and plastic and reconstructive surgery.
Working in Medical Billing and Coding
According to the BLS, employment for medical records and health information specialists will increase by a slightly faster-than-average rate of 9% from 2020-2030. Most jobs will be in these settings:
Hospitals (State, Local, and Private)
Hospitals are the major employer of medical records and health information specialists, hiring 37% of all workers in this category. While specific duties depend on the hospital size, medical billers and coders help manage revenue cycles. With accurate and up-to-date revenue data, hospitals can receive insurance reimbursements and payments from patients on schedule.
Doctors' offices need reliable medical coding and billing services. Larger clinics may offer higher salaries, but smaller offices might provide a less stressful environment with lower caseloads. Doctors' offices, especially smaller practices, often hire individuals who perform both billing and coding roles.
Administrative and Support Services
Many healthcare providers, government agencies, and insurance carriers rely on medical billers and coders in administrative and support roles. They design and carry out procedures that can boost efficiency and profitability.
Large healthcare facilities hire IT specialists and consultants to streamline coding and billing work. In smaller settings, administrative assistants with coding and billing expertise handle patient questions and process claims.
At insurance agencies, these professionals verify claims and work with patients to gather information and explain benefits.
Professional, Scientific, and Technical Services
This category includes colleges, law offices, insurance agencies, and IT companies. Colleges and technology schools hire experienced medical coders to train the next generation. Law offices hire coding and billing specialists to investigate fraud claims.
As the use of electronic health records becomes more prevalent, IT departments will hire more medical billing and coding experts to create, improve, and modify coding and billing systems.
Government agencies hire medical billers and coders to work on research projects. In these settings, they collect and analyze medical data for population health studies and healthcare policy reform.
Management of Companies and Enterprises
Medical billers and coders can take advantage of leadership opportunities as auditors, administrators, operations managers, and trainers. They often work in insurance, private healthcare systems, and accounting and payroll services.
Medical Billing and Coding: FAQs
How long does it take to become a medical billing and coding specialist?
Individuals can move into entry-level medical and billing careers after earning high school diplomas or GED certificates. However, job prospects typically increase with advanced training. Diploma programs take a year or less to complete. Most associate degrees require two years. Completing certification requirements may mean more time before finding a job.
How can I become a medical coder fast?
Medical billing and coding programs offered by vocational or technical schools provide the fastest pathway to a job. Some programs take six months or less. The amount of time depends on the specialty and full-time versus part-time enrollment.
How much does a medical coder make hourly?
According to AAPC, California pays the highest average hourly wage of $30.98. Alabama has the lowest with $22.63.
Is medical coding a stressful job?
Medical billers and coders may experience stress depending on their work environment. Billers and coders employed in small clinics and medical practices may feel less pressure than those who work for large healthcare providers and insurance companies. Billers and coders who work remotely report less stress and greater job satisfaction.
Learn More About Medical Billing and Coding
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