Are you interested in a career change? Do you want to stop working nights, weekends, and holidays? Making the transition from clinical nurse to medical coder may help balance your work and life.
Registered nurse (RN) coders are in demand. RN coder careers are expected to grow 9% by 2030 according to the U.S. Bureau of Labor Statistics.
RNs 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. Read more to find out about this job opportunity and how it may fit your lifestyle.
What Is an RN Coder?
Nurse coding 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 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.)
Steps to Becoming an RN Coder
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.
Earn an associate degree in nursing (ADN) or bachelor of science in nursing (BSN)
Pass the NCLEX exam
Gain experience in nursing
Become a certified coder or auditor
Candidates must have two years of experience as a medical coder for full CPC certification. Those without two years of experience are awarded an apprentice status until the two years are complete. Aspiring RN coders can sit for the CPC exam after paying the required fee and becoming an AAPC member.
RN Coder Education
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.
An associate degree in nursing is best for students who prefer to begin working as quickly as possible. This degree has a high clinical focus. It allows ADN nurses to work while completing a four-year degree if they choose. Although many employers will accept an ADN, most prefer a BSN.
- Admission Requirements: ADN applicants must have a high school diploma or GED certificate. They must submit a personal essay and recent SAT scores. Applicants must have taken high school chemistry and biology. Some programs also require the Health Education Systems Incorporated test to evaluate learning style.
- Program Curriculum: The ADN curriculum prepares students for a clinical role. Students take chemistry, microbiology, anatomy and physiology, and pharmacology. They also have to pass English, communications, behavioral health, and foundations in nursing. Students must complete clinical hours where they apply classroom knowledge in hospitals, rehabilitation centers, and nursing homes.
- Time to Complete: Full-time students can complete an ADN program in two years.
- Skills Learned: Students learn how to perform basic clinical skills, such as how to make a bed with a person in it, take blood pressure and heart rate, give an injection, and insert a catheter.
Candidates may complete a bachelor of science in nursing degree as their first choice or attend an RN-to-BSN program online or in person. This degree covers everything in the ADN program with more emphasis on critical thinking, research, management, and communication skills. The additional education can offer advantages for an RN coder.
- Admission Requirements: Although admission requirements for a BSN degree differ among programs, many require a minimum high school GPA of 3.2 and prerequisite classes in science, English, sociology, and psychology.
- Program Curriculum: BSN students take classes in anatomy and physiology, human development, microbiology, pathophysiology, health assessment, pharmacology, leadership and management, and mental health. Compared to ADN learners, BSN students will spend more time completing a clinical and will have more clinical hours upon graduating.
- Time to Complete: A BSN program generally takes eight semesters (four years). It can take longer if a student attends part time.
- Skills Learned: BSN students learn to assess a patient's physical and mental status, apply critical thinking, and develop strong communication and leadership skills.
RN Coder Licensure and Certification
RN coders are highly sought after for their medical expertise. Maintaining an RN license and earning coder certification demonstrates commitment to the profession. It also helps protect an employer's compliance with insurance companies and agencies like the Centers for Medicare & Medicaid Services.
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 who have graduated 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's 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 $100 and individual membership is $180.
The test is 150 multiple-choice questions and takes five hours and 40 minutes. Exam locations are across the U.S. Certification is not official until two years of medical coding experience are completed.
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.
Working as an RN Coder
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 $74,130 as per September 2021 ZipRecruiter data. This is nearly identical to the median annual salary for an RN according to the U.S. Bureau of Labor Statistics.
Additional certifications can increase job prospects. RN coders can find employment in several different settings:
Becoming an RN Coder: FAQs
How long does it take to become an RN coder?
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.
How do you gain experience as an RN coder?
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.
What qualities are important for RN coders?
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.
Which certifications are most important for RN coders?
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.
Shri Deshaies MSN, RN, CCRN, is a nurse educator with over 20 years of teaching experience. She is a certified critical care nurse and has worked in various surgical intensive care units, including cardiovascular, trauma, and neurosurgery. Her passion for health equity led her to becoming a community home health nurse. She is a founding member of Nurses Serving our Neighbors which advocates for the homeless population. Deshaies recently completed a course to become a faith community nurse.
Shrilekha Deshaies is a paid member of our Healthcare Review Partner Network. Learn more about our review partners.
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