A Career in Medical Billing & Coding

A Growing Field

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.

"It's become so specialized, with so many rules and regulations, it takes a lot of training to do it right," reported Linda McNeil, the president-elect of a Seattle chapter of the American Academy of Professional Coders (AAPA). "At the hospital where I work, we require certification within six months of employment."

Certification & Training

Certification allows new coders to demonstrate their skills, even before they have experience in the field, and certified coders command higher salaries than those who lack credentials. Several levels of certification are available, all requiring formal training. Programs of study take one to two years to complete. Additional specialty certification is available for coders already working in the field. Certified coders must earn continuing education credits each year to maintain their status.

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.

What Coders Do

Coders assign alphanumeric codes to specific illnesses, injuries, and medical procedures, under a system of coding that is used across the health care system, from doctor’s offices and hospitals to insurance companies, federal agencies and international organizations. Hospitals and doctors use the codes for internal data collection and planning, while insurance companies and public agencies require the codes to reimburse health care providers. The codes are even used by international health organizations to track patterns of disease and the costs of health care.

Patience & Determination

Medical billers and coders need patience and the ability to focus on details—a coding error can cause a delayed payment for services, frustrating to both doctors and patients. Problem-solving skills are also essential.

"You have to be an investigator," said Madeline Garrett, a coder in a mid-size hospital. "You're hunting down a mystery to find this person's most important diagnostic." Her colleague, Linda McNeil agreed. "Coders have to be really aware when they translate from medical language to coding. You have to be a little detective to figure out which part of a report is important for the coding," she said.

In smaller settings, where billing and coding positions may include contact with patients, families, doctors and insurance companies, the position demands determination. "You can't take no for an answer—you have to be aggressive," said Lisa Horton, a medical coder in a private physician's office. "You need to be understanding, but still authoritative, not too timid." Because positions in physicians' offices are increasing more rapidly than other parts of the field, these skills will be in high demand.

Growth & Change

The whole field of medical billing and coding is growing much faster than the average, according to the US Department of Labor. The median salary for medical coding and billing in 2002 was $23,890, with a range from about $16,000 to over $38,600 per year. Coders and billers in large organizations such as nursing care facilities and hospitals earned slightly more than those employed by physicians.

McNeil anticipates continued growth and change for medical coding and billing. "It's growing very fast. Some codes change every year, and soon they'll upgrade all of the diagnosis codes. It takes work to keep up with what's current. Our organization (AAPA) provides newsletters, training, networking and meetings." She also notes changes in the work force. "A lot of women work in the field, but I see men breaking into it more."