What is a Medical Billing and Coding Specialist?

Medical billing and coding specialist has one of the jobs that is growing the fastest in the U.S. The U.S. Bureau of Labor Statistics (BLS) calls these people “medical secretaries.” The field is expected to grow by 8% between 2021 and 2031, adding 53,600 jobs. The aging population’s need for more healthcare services is expected to increase demand.

Every healthcare facility requires someone to handle insurance and patient billing and coding. Doctors or office managers may perform these duties in addition to their other duties or hire one or more staff members. Because clinical workers are often preoccupied with patient care, it is often left to trained specialists to manage the critical administrative work of billing and coding to ensure that healthcare providers are reimbursed for their services.

Do you like the idea of working as a billing and coding specialist? Let’s look at what it takes to succeed in this rapidly expanding industry.

What is a Medical Billing and Coding Specialist?

A medical billing and coding specialist is a point of contact between the medical office and insurance companies.

What exactly does this mean?

A billing and coding specialist manages insurance claims, invoices, and payments for the healthcare facility. A medical coding and billing specialist’s day-to-day responsibilities include the following:

• Coding services, procedures, diagnoses, and treatments correctly
• Creating and sending invoices or payment claims
• Resolving rejected claims
• Payment tracking
• Following up with patients and insurance companies regarding unpaid bills

While these employees frequently work in the same healthcare facility where patients are treated, this is primarily an office job rather than patient-facing clinical work. A person specializing in medical billing and coding will spend a lot of time at a computer reviewing, entering, and changing data.

The Difference between Billing vs Coding

Billing and coding are frequently combined in job descriptions. They are, however, two distinct job functions, each with its own responsibilities and tasks.

Many healthcare offices will hire the same person to do both jobs. However, more extensive facilities may divide the work into two different positions—so understanding the distinction between the two roles is critical.

What Is the Role of a Medical Coder?

Medical coding is converting a provider’s diagnostic and procedural notes into the appropriate codes for record-keeping and billing. The codes are alphanumeric combinations used in the industry to identify and bill for services. This will necessitate knowledge of the various codes used:

• CPT (Current Procedural Terminology) codes identify specific procedures and examinations.
• ICD-10 – International Classification of Diseases – These classification codes are used for medical diagnoses.
• Healthcare Common Procedure Coding System (HCPCS) – This system includes codes not covered in the previous two sets, such as codes for specific medical devices or supplies and for non-physician services.

Each of these codes is used in insurance billing, and the coder must adhere to strict guidelines for proper usage and placement in the billing software.

As soon as the patient makes an appointment, codes can be entered. The type of visit and the symptoms reported by the patient will be coded. Additional codes will be assigned for symptoms observed by medical personnel, tests and procedures performed, diagnoses made, and treatments recommended.

What Is the Role of a Medical Biller?

Following the completion of the coding, medical billing specialists generate invoices and submit claims to patients’ insurance providers (or other payers). Insurance companies will approve or deny payment requests based on these codes. Any balance not covered by insurance will be sent to the patient for payment.

The billing process frequently begins when the patient schedules an appointment with the medical office, as codes are entered and submitted to an insurer for pre-approval. This assists in determining the patient’s out-of-pocket expenses, which the office can charge the patient for during the visit.

A medical biller must understand the industry codes even if someone else codes the claims. The billing specialist must review the reasons for denied insurance claims and may be responsible for updating the codes before resubmitting the claims. A medical biller will also double-check the codes before submitting the initial claim.

The remaining balance will be invoiced to the patient once the insurance billing is settled. This is also the responsibility of the medical billing specialist. Medical billers also determine co-pay requirements, track payments, and follow up with insurance companies and patients on outstanding payments.

If a bill is not paid, the billing specialist must contact insurance companies to ensure that all paperwork is in order. If a patient fails to pay an outstanding bill within a specified timeframe and fails to respond to further requests, the billing specialist may be forced to refer the debt to a collection agency.

Combining Medical Billing and Coding 

Because billing and coding are so intertwined, many medical offices employ billing and coding specialists trained to perform both roles. While some more extensive facilities will hire separate teams to handle billing and coding, these individuals typically collaborate closely to ensure the process is completed correctly. The most important aspect is to avoid billing and coding errors so that payments are collected on time.

Other requirements

While job titles and descriptions for medical billing and coding specialist careers may differ, the basic requirements are frequently the same. Although the familiarity with the codes is a common requirement, other knowledge areas can improve your chances of getting hired.

Medical Terminology

A basic understanding of medical terminology is required to code correctly. This includes terms from anatomy and physiology and diagnostic and procedural terminology. Understanding the most commonly used medical terminology will aid in billing and coding.

Basic Math Skills

To determine the correct billing amounts, you must be able to perform basic arithmetic. While the billing system may populate forms with the correct amounts for insurance claims based on the codes entered, you may need to calculate the remaining amounts due from patients or set up payment plans where applicable.

Computer Skills

Medical billing and coding necessitate understanding computer systems and relevant medical software. It is also advantageous to be able to learn new programs.

Communication Skills

Contacting patients for payment may be a part of the medical billing process. This aspect of the job requires the ability to communicate effectively and professionally. When faced with medical problems and a large bill, some patients may become stressed, upset, or angry, so good communication skills can help make these conversations a little easier.

Use of Basic Office Equipment

Aside from computer skills, a medical billing and coding specialist must be able to operate basic office equipment such as a 10-key calculator, printer, copier, scanner, phone system, and so on. You’ve probably used these tools if you’ve ever worked in an office.

Medical Coding Certification

While not every employer requires certification to hire a medical billing and coding specialist, having industry certification, such as the AAPC’s Certified Professional Coder (CPC®) credential, can help you stand out as a candidate.

While work experience and other eligibility requirements are required for full CPC certification, those who pass the certification exam but do not meet the experience requirements may be awarded the CPC Apprentice (CPC-A) designation. A CPC Apprentice may advance to full CPC status by submitting proof of two years of on-the-job experience or 80 contact hours of a coding preparation course plus one year of experience.

Medical Billing and Coding Wages

According to the BLS, the median annual salary for a medical secretary, which includes medical billers and coders, was $37,450 in 2021. Half of the medical billing and coding specialists earn more and less.

The top 10% of earners in this field earned more than $63,100, which may reflect the salary level of those with more work experience. The bottom 10% (lowest decile) of earners in this field earn an average of $29,040 and $13.96 hourly, which may reflect entry-level work experience. Graduates of UMA’s medical billing and coding programs in the 2021-2022 cohort reported earning a median hourly wage at or slightly above the BLS’s lowest decile. 1

As you gain experience in the field, you may be able to earn more, especially if you advance to senior-level or supervisory positions.

Who Is a Good Fit for a Medical Billing and Coding Career?

A medical billing and coding specialist must be well-organized. A medical billing and coding job may be a good fit for you if you are a detail-oriented professional who can manage time effectively and handle multiple projects.

Candidates should also be at ease in an office setting, as the job entails spending a significant amount of time in front of a computer screen and working with patient files. Understanding medical terminology or being willing to learn it is essential. Workers in this field will also need to stay updated on changes in procedures and coding guidelines, so a desire to learn new things is a desirable trait for this position.