Medical Billing and Coding

As insurance companies and health care agencies require more highly detailed records of services provided to patients, the need for medical billing and coding professionals has grown rapidly. A trained, experienced medical biller or coder is a valuable member of any health care team. Without his or her contribution, payments for services may be denied or delayed. Training programs can take less than a year, making this career attractive to anyone wanting to change careers or enter the workforce with a minimum training period and maximum job opportunities.

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Medical coders perform the following tasks:

• Maintain patients' records
• Ensure compliance with federal regulations and insurance requirements
• Assign alphanumeric codes to specific illnesses, injuries and medical procedures using a universally recognized coding system (the ICD-9 index)

Hospitals and doctors use the ICD-9 index for internal data collection and planning, while insurance companies and public agencies require the codes to reimburse health care providers.

Medical billing is a subspecialty of medical coding. The medical biller must be proficient in the following duties:

• Understanding billing procedures
• Fee scheduling
• Collection methods
• Claims form completion

The medical biller must also be able to process responses from health insurance companies. They prepare patients' invoices and must occasionally contact patients regarding past due bills.

Medical billers and coders require patience, the ability to focus and good problem-solving skills. With these traits, as well as training and experience, they enjoy excellent job prospects, competitive salaries and numerous avenues for advancement.

Workplace

Medical billing and coding specialists usually work in clean, relaxed office settings. Jobs are available in physicians' offices, hospitals, pharmacies, nursing homes and rehabilitation centers, but often the biller or coder works in a space separate from where patients are treated. There are also positions in insurance companies, accounting and legal offices, and consulting firms. Many specialists work from home, either running a home business by getting independent physicians as clients or working for larger firms that provide them with workload.

In physicians' offices, billing and coding specialists may interact with patients, families, doctors and insurance companies. This setting demands excellent communication skills as the people contacted are either colleagues or part of the practice, or they are patients who could be at stressful points in their lives.

Education and Training

Although there is no set standard for educational requirements in this field, employers increasingly prefer candidates with some formal medical billing and coding training at an accredited vocational school due to the legal ramifications and insurance risks of improper coding. Most accredited programs of study take nine months to two years to complete. Shorter programs are generally not advised. While there are programs that offer training in medical billing only, programs that combine both billing and coding are preferred by most employers.

Students of medical billing and coding take classes in writing and interpersonal communication, computer skills and the conventions of the coding system itself. They also learn about anatomy, disease, pharmacology and health care management. For advancement in the field, some students take additional courses in biology, science and medical care. Medical billing and coding specialists will also need to have a typing speed of at least 35 to 45 words per minute and good computer skills.

Licensing and Certification

Certification allows new medical billing and coding specialists to demonstrate their skills even before they have experience in the field, and certified specialists command higher salaries than those who lack credentials. Several levels of certification are available, all requiring formal training. Because some of the certifications are new, it is advisable to consult your training program's career counselor about which best suits your needs. Specialty certification is available for coders already working in the field. Maintaining certification requires continuing education credits each year.

More information on certifications is available from the American Academy of Professional Coders, the American Medical Billing Association and the National Healthcareer Association.