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Medical Billing and Coding Certification: Is it Required?

Certifications are optional, but they can help medical billers and coders land jobs and increase their salary.

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Home » Medical Billing & Coding » Certification

Certifications demonstrate that medical billers and coders have gone beyond studying the information and practicing the skills needed for the job. Certifications are only earned after passing an exam that tests them on skills specifically related to the certification—usually within time limits.

In other words, a certification acts as an additional confirmation you have the field-specific skills and know-how to thrive as a medical biller and coder.

Certifications are optional but “help you get your foot in the door,” explains Robyn Korn, MBA, RHIA, CPHQ, adjunct instructor of medical coding at Purdue University Global.

They are particularly helpful for getting hired in competitive job markets. “Some institutions, like hospital-based organizations, are going to be picky to hire someone who has a professional credential,” says Nancy Szwydek, MPH, RN, RHIA, CRAT, CMAC, who is assistant dean for accreditation at Purdue University Global. “As much as they are voluntary, it’s almost necessary to earn a certification for some jobs.” 

Certifications aren’t required, but they may help you advance your career and salary.

You can take a certification exam after you finish your medical billing and coding education; these are not part of your regular coursework or tied to graduation. Some certifications are tied to medical billing, but most are for medical coders.

These certifications fall into two categories: foundational certifications, which show your mastery of billing and coding skills needed across the board, and specialty certifications, which relate to niche medical fields.

Certifications typically require intensive preparation, and taking the exam is no joke, either: Some exams last nearly six hours. That effort can pay off, though—literally. Medical billers and coders with a certification tend to earn higher wages, and salaries increase with the number of certifications you have.

“Credentials take you further than just completing a coding program,” says Korn. “They show employers you have a really strong knowledge base in that arena.”

Can Certification Affect My Pay?

Certifications can absolutely increase your pay. Employers recognize the level of mastery required to earn a certification, and they are usually willing to adjust your pay accordingly.

What Certifications are Available?

There are many certifications for medical billers and coders, and they range from the foundational (like certified coding associate) to the specific (such as anesthesia and pain management.) It’s not uncommon for someone to complete a medical billing and coding program, and then earn a certification while they work.

It’s not uncommon for someone to graduate from a medical billing and coding program or degree, then gradually earn a certification while they work.

Certifications can relate to a field of medicine (such as obstetrics and gynecology) at the facility where you work. You can also earn certifications in a type of medical billing and coding (such as risk management), which can be leveraged anywhere you work.

Some of the most common and popular certifications include:

Certified Coding Associate (CCA)


  • This entry-level certification demonstrates your skill for coding in both physician’s offices and hospitals.
  • Recommended but not required: Six months’ experience as a coder and completion of a program or degree that includes diagnostic coding and CPT coding.
  • Exam overview: The two-hour, computer-based exam covers six areas of coding, including methods for reimbursement and clinical classification systems.
  • Preparing for the exam: American Health Information Management Association (AHIMA) offers a prep course, the Professional Certificate Approval Program (PCAP).

Certified Coding Specialist (CCS)


  • This certification is a step up and demonstrates additional expertise in accurately coding medical diagnoses and procedures.
  • Recommended but not required: One to two years of experience, or a CCS, CCS-P, RHIT, or RHIA credential.
  • Exam overview: The four-hour exam uses multiple choice questions and medical scenarios to primarily assess coding skills. Other testing areas include coding documentation, communication with providers, and regulatory compliance.
  • Preparing for the exam: AHIMA offers prep classes and books.

Certified Coding Specialist–Physician Based (CCS-P)


  • This certification shows coding excellence in settings where physicians work, such as private and group practices.
  • Recommended but not required: One to two years of coding experience in a physician-based medical setting, or a CCA, CCS, RHIT, or RHIA credential.
  • Exam overview: The four-hour exam tests diagnostic coding, procedure coding, and other skills such as compliance and research.
  • Preparing for the exam: AHIMA sells a range of books to help you prepare.

Certified Professional Coder (CPC)


  • A CPC certification shows your proficiency in coding for evaluation, anesthesia, and other medical services, plus your ability to apply medical coding to reimbursement processes.
  • Prerequisites: Membership in the American Academy of Professional Coders (AAPC), at least two years’ medical coding experience; an associate degree is recommended but not required.
  • Exam overview: The exam, which is offered online, takes up to five hours and 40 minutes.
  • Preparing for the exam: The AAPC offers online or in-person training and online practice exams.

Certified Outpatient Coder (COC)


  • A medical coder who specializes in outpatient facilities can show their expertise in medical codes for diagnoses, procedures, and services in outpatient settings with this certification.
  • Prerequisites: AAPC membership, at least two years’ medical coding experience; an associate degree is recommended but not required.
  • Exam overview: The computer-based exam takes up to five hours and 40 minutes. It covers medical terminology, methods of payment, compliance, and skill with multiple coding systems.
  • Preparing for the exam: The AAPC offers online or in-person training and online practice exams.

Certified Inpatient Coder (CIC)


  • The CIC focuses entirely on inpatient hospital and facility coding, including specialized payment knowledge.
  • Prerequisites: AAPC membership
  • Recommended but not required: An associate degree and two or more years of experience with coding in an inpatient setting.
  • Exam overview: The computer-based exam takes up to five hours and 40 minutes. It covers coding using ICD-10-PCS and ICD-10-CM coding systems for inpatient services.
  • Preparing for the exam: The AAPC offers online or in-person training and online practice exams.

Certified Risk Adjustment Coder (CRC)


  • Successfully completing this certification shows your expertise in medical coding for patients with high-risk adjustment scores, including understanding of audits.
  • Prerequisites: Associate degree and two years of experience in risk adjustment coding or a risk adjustment coding course recommended.
  • Exam overview: The computer-based exam takes up to five hours and 40 minutes. It covers using risk adjustment models, coding, and reducing deficiencies in documentation to reduce the chance of audits.
  • Preparing for the exam: The AAPC offers online or in-person training and online practice exams.

Certified Medical Coder (CMC)


  • CMCs have demonstrated expertise in medical coding for outpatient settings.
  • Prerequisites: Minimum one year of professional coding experience.
  • Exam overview: Candidates complete a written exam in six hours or less, using current coding books to code to the highest degree of specificity.
  • Preparing for the exam: The Practice Management Institute provides prep materials and courses.

Billing Coding Specialist Certification (BCSC)


  • Certification holders are accountable for sustaining and correctly reporting all patient data.
  • Prerequisites: 18 or older, high school diploma or GED, and completion of a billing training program or at least one year of related work experience.
  • Exam overview: Over two hours, candidates answer 100 questions on regulations, insurance types, anatomy and physiology, medical terminology, and various coding systems. Exams can be taken online via live remote proctoring.
  • Preparing for the exam: Study materials are included with the price of the exam.

Certified Medical Reimbursement Specialist (CMRS)


  • This certification for billers demonstrates their ability to correctly bill and keep the revenue cycle moving.
  • Prerequisites: American Medical Billing Association (AMBA) membership and high school diploma or GED.
  • Exam overview: The CMRS exam is delivered online over the course of 45 days. Candidates are allowed and encouraged to use resources, including the internet, to best answer exam questions. This exam is only offered online.
  • Preparing for the exam: AMBA provides a study guide.

How Do I Decide Which Certification to Pursue?

With an entire alphabet of certification options, it can feel overwhelming to choose a direction. Follow this advice to chart a course.

Networking:

“Networking can show you which types of credentials are in high demand,” Korn says. Ask other professionals during conferences and social events, or on online discussion boards about the trends they see in hiring needs and what certifications employers are looking for.

Job postings:

You can skim job posting sites to find in-demand certifications. Most openings include minimum or ideal requirements, which may list credentials.

Specialties:

After you’ve worked in the field, you’ll probably discover that you’re more passionate about particular areas of billing and coding. You can earn certifications that will help move your career to focus on those interests. For example, if you love working around kids, you can earn a certification in pediatrics.

Who Certifies Billers and Coders?

Two groups grant certifications in medical billing and coding. They offer different certifications, each of which demonstrate skill and expertise in a given area.

American Academy of Professional Coders (AAPC):

The AAPC offers exams for certification in medical billing, medical coding, compliance, auditing, and other subjects. It also provides ongoing education opportunities; continued education credits are required to maintain most certifications.

American Health Information Management Association (AHIMA):

Credentials from AHIMA emphasize practical skills needed in maintaining healthcare records. The organization offers multiple coding certifications and specialty certifications.

What About Specialty Certifications?

The AAPC provides coding specialty certifications, which are designed for professionals with significant experience in a medical subfield, such as radiology or anesthesia. These are optional but offer an opportunity to specialize, potentially increasing your earnings and ability to work in increasingly specialized medical settings. On average, medical coders with a specialty certification earn more than those without.

Medical coders with a specialty certification typically earn more than coders without.

“A biller/coder’s day-to-day work is similar in many settings,” Szwydek says. “What varies is the specialization you may need. For example, if you work in an oncology department at a hospital, you may need a certification in hematology and oncology.”

Exams for these certifications are designed to mirror “real life” scenarios by testing how candidates apply coding skills and knowledge of specialty regulations in response to examples of patient notes. Many of these exams can be completed online. (Many billing and coding educational programs can be completed remotely as well.)

Specialty certifications demonstrate expertise in narrow medical fields. These include:

Ambulatory Surgical Center (CASCC):

using medical coding for surgery and other treatments, as well as the use of pharmaceuticals, at an ambulatory surgical center (ASC). A coder with this certification would work at an ASC.

Anesthesia and Pain Management (CANPC):

using medical coding for anesthesia cases. A coder with this certification would work in facilities that perform surgery.

Cardiology (CCC):

using coding systems to code from physician notes and coding surgical procedures performed by cardiologists. A coder with this certification would work in the cardiovascular department of a hospital.

Cardiovascular and Thoracic Surgery (CCVTC):

correctly coding visits and surgeries performed by cardiovascular and thoracic surgeons. A coder with this certification would work in the surgery department of a hospital.

Dermatology (CPCD):

using coding systems to identify dermatology-related procedures, diagnoses, and surgeries. A coder with this certification would work with dermatologists, either in a hospital or physician’s practice.

Emergency Department (CEDC):

coding surgical procedures, sedation, and other procedures common to emergency departments. A coder with this certification would work in the emergency department of a hospital.

Evaluation and Management (CEMC):

using sound judgment on subjective aspects of documentation, plus risk assessment and time-based coding. A coder with this certification could work for a health system or hospital.

Family Practice (CFPC):

using coding systems for services and procedures common in family practices, plus knowledge of evaluation and management coding. A coder with this certification could work in group practices of family physicians.

Gastroenterology (CGIC):

coding services, treatments, and surgeries performed by a gastroenterologist. A coder with this certification would work in the gastroenterology department of a hospital.

General Surgery (CGSC):

coding for surgical procedures such as colonoscopy and hernia repairs. A coder with this certification would work alongside surgeons in a hospital.

Hematology and Oncology (CHONC):

coding and regulations for services related to hematology and oncology, such as chemotherapy, bone marrow biopsies, and venipuncture. A coder with this certification would work in an oncology department in a hospital or a lab in a hospital, health system, clinic, or medical laboratory.

Interventional Radiology and Cardiovascular (CIRCC):

coding for this radiology subspecialty, which has a high average error rate and high potential for earning. A coder with this certification would work in the radiology or cardiovascular units in a hospital or health system, or an imaging center.

Obstetrics Gynecology (COBGC):

coding of obstetric services, including prenatal care, deliveries, and postpartum care, as well as hysterectomies and biopsies. A coder with this certification would work in the obstetrics/gynecology units in hospitals or health systems, a standalone clinic, a midwifery practice, or a multi-physician practice.

Ophthalmology (COPC):

coding procedures and surgeries performed by ophthalmologists. A coder with this certification would work in a specialized ophthalmology department within a hospital or health system.

Orthopedic Surgery (COSC):

coding surgeries and services performed by orthopedists, including fracture repairs and spine surgeries. A coder with this certification would work in the orthopedics department of a health system or hospital, or a standalone clinic or multi-physician practice of orthopedics.

Pediatrics (CPEDC):

coding of services, procedures, and minor surgeries, including vaccinations and fracture care. A coder with this certification would work in the pediatrics department of a hospital or health system, or in a clinic or multi-physician practice.

Rheumatology (CRHC):

coding of services and surgical procedures performed by rheumatologists, such as trigger point injections and joint injections. A coder with this certification would work in the rheumatology department of a hospital or health system.

Urology (CUC):

coding for procedures such as urinalysis and surgeries including biopsies performed by urologists, plus time-based coding. A coder with this certification would work in the urology department in a hospital or health system.

Does My Certification Change My Job Description?

Once you earn a certification, your job description doesn’t necessarily change. You may take on a few additional responsibilities, but you will likely perform the same tasks as you did before.

Once you have a certification, you can work toward a promotion in job title and/or compensation.

If you are looking to move your way up in an organization, especially if you aim for managerial positions, certifications will help your aspirations.

catherine gregory

Written and reported by:
Catherine Ryan Gregory
Contributing writer

robyn korn

With professional insight from:
Robyn Korn, MBA, RHIA, CPHQ
Adjunct Instructor of Medical Coding, Purdue University Global

nancy szwydek

With professional insight from:
Nancy Szwydek, MPH, RN, RHIA, CRAT, CMAC
Assistant Dean for Accreditation, Purdue University Global