How to Become a Medical Biller or Coder

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.

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:

The Bureau of Labor Statistics (BLS) projects these healthcare professionals to grow 9% between 2023-2033. 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), the average annual medical biller and coder salary is $54,800. Earnings vary with setting, education level, certifications, and experience.

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:

Like medical billers, coders can expect an expanding job market through the end of the decade. AAPC reports that coders without certifications make an average yearly salary of $47,200. With certification, this average increases to $60,100. Earnings also vary by specializations, educational level, and experience.

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.

According to the BLS, employment for medical records and health information specialists will increase by a faster-than-average rate of 9% from 2023-2033. Most jobs will be in these settings:

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.

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.

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.

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.

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.

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.

According to AAPC, Washington, D.C., pays the highest average hourly wage of $34.06. Mississippi has the lowest with $22.24.

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.