Individuals in a health-care facility who create and maintain patient records, and facilitate payments and reimbursements, are called medical billing and coding specialists. They code information to create invoices that are sent to patients and third-party payers like insurance companies, then follow up to ensure that payments are made.
Most medical billing and coding specialists are employd in physicians’ offices, medical clinics, hospitals, and other health-care settings. They work either in a business office, separated from the public; or behind a receptionist desk, where the job may include greeting and serving patients. Some of these professionals work at home, on a contract basis.
As is the case with most medical-related occupations, the potential for job growth is strong for medical billing and coding specialists. This is due to the expanding (and aging) population, as well as government subsidies for health insurance and technological innovations that create more medical tests. The profession provides an opportunity to work in health care without having to commit the time and money required for a medical degree.
Medical Billing and Coding Job Description
Without an efficient medical billing and coding specialist, a health-care facility’s operations would quickly grind to a halt. These office workers keep records organized and complete, so invoices and reimbursements can be issued in a timely and accurate manner.
They enter into computer files the personal information and medical histories of patients, the tests they undergo, and the diagnoses and treatments they receive. These specialists then convert the data into a coded form that insurance companies require, and that help to protect patients’ privacy. The job duties of medical billing and coder include:
- Enter patient information into computer files, and possibly also in paper records
- Organize, manage, and sort paperwork (including patients’ charts)
- Continue to enter data as patients are subjected to diagnostic tests and receive treatments
- Translate the information into alphanumeric medical code
- Prepare and mail billing statements
- Submit claims to insurance companies and other third-party payers
- Process payments from insurance companies
- Post transactions and reconcile payments to patient ledgers
- Collect and manage patient account payments
- Identify past-due bills and recommended collection actions
- Ensure that the facility is reimbursed for all services provided
- Resolve conflicts regarding payments and reimbursements
- Write reports and provide information to government agencies
- Respond in writing and on the telephone to patients’ questions about billing
- Investigate and report instances of insurance fraud
- Provide information and prepare documents for legal inquiries and litigation
- Ensure the confidentiality of patients’ personal information
- Perform clerical duties that may include answering the telephone, greeting patients, and sorting mail
Medical Billing and Coding Prerequisites
Medical billing and coding specialists spend much of their time sitting in front of computer screens, doing repetitive motions. This can lead to stiff necks, strained eyes, and other physical maladies. There also is a risk of coming into contact with infectious diseases, especially when the job duties include working with the public.
Attention to detail, superior organizational skills, and critical-thinking ability are vital. A wide range of information, including statistics, must be accurately recorded and properly organized. A solid knowledge of multiple computer systems is needed.
How to become a Medical Coder
A college degree is generally not required for this position. However, most employers ask for some experience and training in a medical office. Applicants with proven computer expertise, and who got good grades in high school science, health, and math classes, may be preferred.
To further enhance the odds of getting hired, a student can complete a medical billing and coding certificate program at a college or technical school. Classes also may be taken online. Another option is a two-year associate’s degree in health information management from an institution recognized by the Commission on Accreditation for Health Information Management Education. Four-year bachelor’s degrees in health information technology also are available.
With experience and training, a specialist may be eligible for promotion to chief of the billing department, supervisor, or office manager.
Medical Billing and Coding Certification
Some employers mandate certification as a medical reimbursement specialist. To earn this certificate, an applicant must pass an exam that covers medical terminology, computer database management, and billing and coding procedures. Other employers will only hire graduates from an accredited program. Certification must be renewed annually through CE courses completed online or in workshops. Some designations may include Certified Tumor Registrar (CTR) or Registered Health Information Technician (RHIT).
Medical Billing and Coding Salary
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Medical Billing and Coding Job DescriptionHere is a short recap of the medical billing and coding job description:
- Maintain patient records and facilitate medical payments
- Integral part of physician offices and hospitals
- No formal education required
- Certification not required but recommended
- 22% employment growth by 2022