What’s Medical Billing & Coding? Job Description & Career Paths

Medical billing and coding careers are fast-paced. Learn what you can expect on the job.

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What Does a Medical Biller and Coder Do?

Medical billers and coders play a vital role in the connection between health care providers, patients, and insurance companies. As a medical biller and coder, you’ll need to read patient charts to determine medical history, including diagnoses and treatments given. Based on these charts, you’ll use a set of established medical codes in order to transcribe patient history into a type of shorthand that will be used by both health care providers and insurance companies.

A very similar career, and often available through the same programs, is a medical transcriptionist career. Medical transcription jobs have the same goal as medical biller and coder jobs, but medical transcriptionists listen to physicians’ diagnoses and treatment plans and then write down codes based on that, while medical billers and coders get their information from reading patient reports.

It’s worth noting that the current code used to track patient diagnoses and treatments is ICD-11—ICD stands for International Classification of Diseases. ICD-11 gives coders the ability to be much more specific in their documentation over the previous ICD revisions.

A medical biller and coder will have, generally, the same sort of duties no matter what type of facility they’re employed in. From clinics to hospitals to physicians’ offices, medical billers and coders use medical codes to document patient diagnoses and treatments. Specifically, their duties include:

  • Reading and analyzing patient records
  • Determining the correct codes for patient records
  • Using codes to bill insurance providers
  • Interacting with physicians and assistants to ensure accuracy
  • Keeping track of patient data over multiple visits
  • Managing detailed, specifically-coded information
  • Maintaining patient confidentiality and information security

While many medical billers and coders do work on-site in hospitals and clinics, they’re typically far-removed from where patient care is taking place. While you will be required to interact and communicate with physicians and assistants to a certain degree, much of your work will be independent of everything else that goes on in a health care facility.

What Career Paths Can I Take as a Medical Biller and Coder?

Your career as a medical biller and coder will require you to maintain excellent concentration and focus, no matter what environment you’re in. On a day-to-day basis, you will be dealing with all types of patient charts, which you will need to code correctly and then send for billing to insurance companies. Possible places you might work as a medical biller and coder include:

  • Hospitals
  • Physicians’ offices
  • Nursing care facilities
  • Home health care services

A similar career you might choose is a medical transcriptionist career, which will see you in the same sort of workplaces that a medical biller and coder would be in.

The medical billing and coding profession is also popular for those looking for self-employment. In this capacity, you may be consulting on-site at medical facilities or working remotely. Medical coders typically work remotely and partner with a health care facility who sends the information needed to code patient records and bill insurance companies.

Watch Out for Medical Coding Training Scams

You’ve probably seen flyers or ads about work-from-home medical billing and coding jobs. They promise a lucrative career and lots of business, even for people with no experience in the field. Truth is, getting an education that will prepare you to perform the rigorous and detailed tasks that a medical billing and coding career requires is a necessity.

This is a classic case of “if it sounds too good to be true, it probably is” and the Federal Trade Commission has filed charges against many companies for making false claims about how much business can be generated and how much someone can earn.

Because doctors and medical facilities rely on medical billers and coders to get paid, they’re looking for a person with an education from a reputable medical billing and coding program. The good news is, many of these programs are available online from accredited schools. As you research your options here are some of the courses you’ll need knowledge on:

  • Insurance guidelines, the claims submission process, and procedures
  • How to fill out complex insurance claim forms
  • Analyzing Explanation of Benefits (EOB) forms to ensure insurance companies have paid for charges
  • How to generate accounts receivable report clients
  • Following up with the appropriate parties (insurance companies and patients) to ensure bills are paid

If you choose the work-at-home route, you’ll want to research your local market to determine the need for a medical biller. You should also write a business plan and ensure your home has a dedicated area for work. You’ll have to abide by all the same health privacy laws (HIPAA) as a medical office, so having a secure location where no one else can access medical records is absolutely necessary.

Career Advancement

Most medical records and health information technicians work as coders. A growing sector of technicians are working as cancer registrars. Their duties include:

  • Reviewing patient records and pathology reports for accuracy
  • Assigning codes to represent diagnosis and treatment of cancers
  • Conducting annual follow-ups to track treatment
  • Analyzing and compiling patient information for research purposes

While employment for all medical coders is strong and steady, cancer registrars are expected to continue to be in high demand. As the population ages, there will likely be more types of special purpose registries because many more types of illnesses are detected and treated later in life.

Similar career paths include medical and health service management, and there are several professional certifications available, offered by the two main bodies that grant certifications in medical billing and coding: the American Academy of Professional Coders (AAPC), and the American Health Information Management Association (AHIMA). Certification can help you hone in on an area of medical specialty you’re interested in, as well as possibly giving you an edge when it comes to salary.

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