What Is a Medical Coding and Billing Specialist?

What Is a Medical Coding and Billing Specialist?

What Is a Medical Coding and Billing Specialist?

Medical coding and billing specialists work in one of America’s fastest-growing occupations. These workers are included under the broader U.S. Bureau of Labor Statistics (BLS) category of medical secretaries; collectively, this field has a projected employment increase of 22% between 2016 and 2026, resulting in 129,000 new jobs.  Demand is projected to rise with the aging population’s need for more healthcare services.

Every medical facility needs someone to do the medical coding and medical billing for insurance and patient invoices. Doctors or office managers may perform these tasks in addition to their other responsibilities, or they may hire one or more staff members to handle these duties. Since clinical workers are focused on patient care, it often falls to trained specialists to manage the important administrative work of coding and billing to ensure that healthcare providers are reimbursed for their services.

What Is a Medical Coding and Billing Specialist?

A medical coding and billing specialist acts as a liaison between the medical office and insurance companies.

What does this mean?

A coding and billing specialist helps the healthcare facility manage insurance claims, invoices, and payments. The day-to-day work of a medical coding and billing specialist includes:

Properly coding services, procedures, diagnoses, and treatments

Preparing and sending invoices or claims for payment

Correcting rejected claims

Tracking payments

Following up with patients and insurance companies about outstanding bills

While these workers often work in the same healthcare facility where patients go for treatment, this is primarily an office job as opposed to patient-facing clinical work. A medical coding and billing specialist will spend a large amount of time at the computer, reviewing, entering, and updating information.

The Difference Between Billing and Coding

Job descriptions often combine billing and coding within a single position. However, they are technically two different job functions, each with its own responsibilities and tasks. Many medical offices will hire the same person to do both jobs, though larger facilities may divide the work into two separate positions—so it’s important to understand the difference between the two roles.

The Medical Coder

Medical coding is the act of taking a provider’s diagnostic and procedural notes and converting them into the correct codes for record-tracking and billing purposes. The codes are industry-standard alphanumeric combinations used to identify the services being provided and billed. This will require knowledge of the different codes used:

Current Procedural Terminology (CPT) – These codes are used to identify specific procedures and examinations performed.

International Classification of Diseases (ICD-10) – These classification codes are used for medical diagnoses.

Healthcare Common Procedure Coding System (HCPCS) – This system includes codes not covered in the previous two sets, such as codes for specific medical devices or supplies and non-physician services.

Each of these codes is used in insurance billing, and the coder must follow specific guidelines for proper use and placement in the billing software.

Codes may be entered as soon as the patient makes an appointment. There will be codes for the type of visit and the symptoms reported by the patient. Further codes will be applied for the symptoms observed by medical staff, tests and procedures performed, diagnoses, and treatments recommended.

The Medical Biller

After the coding is completed, medical billing specialists generate invoices and send the claims to patients’ insurance providers (or other payers). Based on these codes, insurance companies will approve or deny the requests for payment. Any remaining amount not covered by insurance will then be sent to the patient for payment.

The billing process often begins as soon as the patient makes an appointment with the medical office, as codes may be entered and submitted to an insurer for pre-approval. This helps determine what the patient’s out-of-pocket expenses will be, so the office can charge the patient for that amount at the time of the visit.

A medical biller needs to understand the industry codes even if someone else does the coding, since the billing specialist has to review the reasons behind any denied insurance claims and may be responsible for updating the codes before resubmitting the claims. They will also verify the codes are entered correctly before submitting the initial claim.

Once the insurance billing is settled, the remaining balance will be invoiced to the patient. This process also falls to the medical billing specialist. Medical billers also determine co-pay requirements, track the payments, and follow up on outstanding payments from insurance companies and patients.

If a bill goes unpaid, the billing specialist will need to contact the insurance companies and make sure all the paperwork is in order. If a patient does not submit payment for an outstanding bill within a specified timeframe and does not respond to further requests, the billing specialist may need to turn the debt over to a collection agency.

Combining Billing and Coding

Because the billing and coding processes are so intertwined, many medical offices hire coding and billing specialists with the training to perform both roles. While some larger facilities will hire separate teams to take care of the billing and coding, these individuals typically work very closely together to ensure the process is done correctly. The most important aspect is avoiding coding and billing errors so payments are collected in a timely manner.

Other Requirements

While job titles and descriptions may vary for medical coding and billing specialist careers, the basic requirements will often be the same. Familiarity with the necessary codes is the most important requirement, but there are other knowledge areas that can increase your ability to get hired.

Medical Terminology

To code properly, a basic understanding of medical terminology is essential. This includes anatomy and physiology terms, diagnosis and procedural terminology, etc. Understanding the most commonly used terms in the medical profession will help with the billing and coding process.

Basic Math Skills

You will need to be able to do basic arithmetic to determine the proper billing amounts. While the billing system may automatically populate forms with the proper amounts for insurance claims based on the codes entered, you may need to calculate the remaining amounts due from patients or set up payment plans where applicable.

Computer Skills

The medical billing and coding process requires a working knowledge of computer systems and relevant medical software. The ability to learn new programs is also a plus.

Communication Skills

Part of the medical billing process may involve contacting patients for payment. The ability to communicate effectively and professionally is necessary for this aspect of the job. Some patients may be stressed, upset, or angry when faced with medical problems and a large bill, so good communication skills can help make these conversations a little easier.

Use of Basic Office Equipment

In addition to having a level of computer proficiency, a medical coding and billing specialist will need to be able to use other basic equipment, such as a 10-key calculator, printer, copier, scanner, phone system, and the like. If you have ever worked in an office setting, you have likely used these tools and should have no problem.

Medical Coding Certification

While certification is not required by every employer to get a job as a medical coding and billing specialist, having industry certification can make it easier to get a job. Medical coding certification may also increase your earning potential.

The BLS reports that the mean or average salary for a medical secretary, under which medical billers and coders fall, was $34,610 per year in 2017. If you earn industry certification, however, such as the Certified Professional Coder (CPC®) credential from the AAPC, and then gain years of experience, you could earn more. The 2017 AAPC Salary Survey states that coders with an average of 13 years of experience and the CPC certification earned an average annual salary of $54,106.

While work experience and other eligibility requirements are necessary for full CPC certification, those who pass the exam but lack the requisite experience may be awarded the CPC Apprentice (CPC-A) designation. Upon submitting proof of two years of on-the-job experience or 80 contact hours of a coding preparation course plus one year of experience, a CPC Apprentice may gain attain full CPC status.

With a combination of formal education, certification, and experience, your earning potential can increase, especially as you move into senior-level or supervisory roles.

A medical office will often require either experience or certification to hire a new billing and coding specialist, and some may require (or prefer) candidates to have both. Earning a diploma or degree in medical billing and coding can help you gain the required knowledge while getting you ready for the certification exam.

Who Is a Good Fit for a Medical Coding and Billing Career?

A medical coding and billing specialist requires good organizational skills. If you are a detail-oriented professional who is able to manage time well and adeptly handle multiple projects, a job in medical billing and coding might be a good fit for you.

Candidates should also be comfortable in an office setting, as the job requires a lot of time in front of a computer screen and working with patient files. It’s important to have a good grasp of medical terminology, or at least be willing to learn it. Workers in this field will also need to stay up to date with changes in procedures and coding guidelines, so an interest in continued learning is also a good quality for this role.

If this description sounds like you, then training for a medical coding and billing specialist position may be a good career choice.

Getting Started in Medical Billing and Coding

Would you like to take advantage of the growth potential in the medical billing and coding industry?

You can get started with an online diploma or degree in medical billing and coding from Ultimate Medical Academy.Not only will your UMA education lead to a credential, but it will also prepare you to take the CPC certification exam.

Once you pass the exam, you can earn the CPC-A designation, which can be updated to full CPC status upon meeting eligibility requirements.

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