Are you an organized person who just can’t help but pay attention to even the smallest details? Are you capable of following a set of directions in order to have a successful end product? Do you have what it takes to work in an administrative capacity in the medical field? Maybe now is the time for you to consider pursuing a career in medical insurance billing and coding. As a medical insurance biller and coder you will be responsible for translating patient information and procedures into billing and insurance codes. It will be up to you to ensure that your employer receives reimbursement from insurance companies for a patient’s medical procedures. Although it is not required to become certified in this profession, it may help you to gain employment over individuals who do not have appropriate certification for this field of study. If you would one-day like to work at home as a medical biller or coder then find an accredited training program below.
In order to be prepared to work in this profession you will want to complete either a certificate based program or an associate’s degree program. Regardless of which of these training programs you choose, it is quite common for students to pursue their education through an online learning format. Within your degree program you will be gaining a foundational understanding of how healthcare organizations work, about career relevant medical terminology, standard medical procedures, and how to correctly perform administrative jobs within a medical office. Your specific coursework will teach you about the most commonly used coding methods that are used in medical offices everywhere and the business classes that you will be required to take will prepare you for the more administrative tasks that you will be required to perform. You can expect to be required to complete specific classes like: human anatomy and physiology, healthcare economics, reimbursement policies, health services organizations, legal concepts in healthcare, CPT coding and billing, and medical terminology. Take a few minutes and check out the schools that are shown on our site. Feel free to request a complimentary information packet from any of the schools that are particularly interesting to you; this will help to make your educational decisions much easier.
With your formal training in this field you will be able to seek employment in a hospital, in a doctor’s office, within an insurance company, or in other healthcare related environments. In addition, you could work as a claims processor, as a medical records specialist, as a health care information technician, or as a medical office assistant. Of course, you will also be qualified to work as a medical biller or as a medical coder.
If you have ever thought about becoming a medical billing and coding specialist (or health information technician), you might consider the wide range of opportunities this career offers. You will be working in the medical field giving administrative support to doctors, insurance companies and other agencies. Minimally, you need good computer skills and some knowledge of medical terminology for an entry level position. A certificate is not always required, but the vast majority of candidates do become certified, so it’s an excellent idea and can certainly provide you with more career opportunities. Most employers do look for candidates that have been certified. There are many online programs that offer courses leading to certification, which we will discuss.
A medical billing and coding specialists needs to be detail-oriented and be able to work with minimal supervision, since he or she will frequently be working alone. If any information is unclear, a billing and coding specialists needs to be able to communicate with health care providers and insurance companies in order to obtain the correct information to process a claim.To understand the need for good medical billing and coding specialists, you need to realize that about 55 percent of claims are miscoded. This has serious consequences for patients and physicians who depend on payment for their treatments. A good billing and coding specialist will be greatly sought after for employment. There are many career paths for a medical billing and coding specialists beyond getting certified. An Associate’s degree or Bachelor’s degree can lead to medical billing team leader and supervisory positions. One of the major benefits of becoming a medical billing and coding specialist is that it affords you the opportunity of working at home, either fulltime or part-time. The position offers tremendous flexibility. All you need is a computer and Wi-Fi hookup. This means you can work anywhere. If you take a trip, you can bring your computer and do your work as needed. Depending on your lifestyle, this can be an important issue.
What Does a Medical Billing and Coding Specialist Do?
Each time a doctor or other healthcare provider provides a service, he or she files a claim with the patient’s insurer. It is the medical billing and coding specialist who will enter a code for each claim and start the process for reimbursement. Every claim will have a unique code that indicates the patient’s problem or ailment and the service that was performed. Each type of encounter has a specific code. These codes tell the insurance company what the patient’s problem was and what sort of service or treatment was performed. This is not as simple as it seems. In order to correctly input the code, the billing and coding specialist must know what the codes mean. In addition, he or she needs to know enough medical terminology to enter the correct code for the correct problem and subsequent treatment.
Much of this information can be in the provider’s own, and often haphazard, notes, notes scribbled in the margins of a report, or by tape recording. Like the notes, the tape recording may be rushed and unclear. Treatment information is rarely given in a clear, logical format. This can put the medical billing and coding specialist in the role of medical investigator as he or she tries to put together clues from notes, charts, transcripts and cryptic recordings. It’s important to correctly interpret and analyze all this important information correctly and input the relevant codes. This is the most important job function of the professional medical billing and coding specialist. It’s the codes that allows an insurance company to review a claim. A medical billing and coding specialist will deal with many insurers, and each insurer will have its own way of doing things. The coder must process the codes accurately for each insurer. Mistakes can result in a wrong medical diagnosis and having the insurance claim rejected. Accuracy is a crucial requirement of the job. While the medical billing and coding specialist deals in codes, it’s important that these codes provide an accurate picture of the patient’s meeting with the doctor and note what is required for reimbursement. Billing codes are a type of shorthand that the billing and coding specialist needs to unravel.
The need for absolute accuracy can cause stress. The billing and coding specialist needs to handle stress on a daily basis. If the insurer requires additional tests to verify a claim, the medical billing and coding specialist needs to work with the physician’s office to ensure the proper paperwork is issued. Medical billers work exclusively for health care providers, while medical coders work with insurers. The distinction is minimal, as they both require the same type of knowledge. Anyone interested in a career as a medical billing and coding specialist should enroll in a program that covers both aspects of the job to increase future job pportunities.When a medical biller and coder works for an insurance company, he or she needs to determine whether the patient’s policy covers the claim. That’s another reason inputting the proper codes is critical.
In a hospital or private practice setting, a medical billing and coding specialist may handle the billing process, such as sending bills to patients and processing the incoming payments. Billing methods vary, from hourly or flat fee, and each has a separate code that must be entered. Since the information is so critical, a billing and coding specialist will likely spend as much time reviewing his or her own input as actually inputting the codes. There is, of course, software available to help with the coding, but a coder must do more. Analyzing results from labs must be done and integrated with physician’s notes to create an overall diagnostic picture. This requires some fundamental knowledge of the medical system as a whole. On-the-job training will broaden a billing and coding specialist’s knowledge, but some medical training is needed, as well as having an excellent mind for details.
In the US, and most of the world, entire medical records are kept in electronic form. Since this involves a great deal of confidential information, a billing and coding specialist must understand privacy laws. Input errors can render medical files vulnerable to security breaches. Again, accuracy is always paramount for a billing and coding specialist. Generally, a medical billing and coding specialist works in administrative settings, away from actual medical situations. As a rule, there is little patient contact. However, there are times when direct interaction with a patient may become necessary. This usually involves some dispute over treatment. If a specific treatment is coded, but the patient disputes receiving such treatment, the coder must verify the information by either talking to the patient or the medical provider. If in doubt, the specialist must verify information before inputting the data.The same specialist may also work with medical facilities and insurance companies to clarify any disputes regarding payments and coverage eligibility. This is the medical billing and coding specialist’s area of expertise, and his or her input is important to maintaining an accurate patient file.
Eighty percent of medical practices have patients covered by Medicaid and Medicare. This can present special problems involving special forms. Medicare parts C and D can get especially confusing, since a portion gets billed to a private insurance company. This means there can be two separate claims for the billing and coding specialist to handle and input. Sometimes, it can be unclear which insurer is responsible for which procedure. If the insurer rejects the claim, the responsibility for payment goes directly to the patient. Billing and coding for Medicare patients represent the special challenges. More importantly, Medicaid laws and regulations vary, depending on location. It is up to the biller and coder to be familiar with his or her state’s specific coding protocols. Medical billing and coding programs offer special courses in coding for Medicare and Medicaid. Billing and coding applicants who are familiar with this confusing procedure have a definite advantage in the job market. Make sure your program has these courses available.
Where do Medical Billing and Coding Specialists Work?
Medical billing and coding specialists work in hospitals, clinics, residential care facilities and nursing homes, insurance companies, and government agencies involved in the national healthcare system. It’s not uncommon for medical billing and coding specialists to work from home. This can happen when a specialist is starting out in his or her career or is at the point where he or she has enough experience to work independently. Independent specialists need to attract doctors or clinics who seek their services as clients. Even a handful of regular clients can provide a good income stream, because each physician will be processing several procedures each day. To get started in your home business, you will need up to $3,000 in equipment, software and office supplies. Some locations may require a business license. Otherwise, there is no additional overhead.
After getting the necessary equipment, your next step is to market yourself. An excellent starting point is to work for a temporary agency that specializes in medical billing. This is also an excellent way to gain experience. Good work habits can attract the attention of medical providers who can become your private clients. To build your own business, send letters to local doctors’ offices and clinics offering your services. Join professional organizations that put you in direct contact with potential clients. Working part-time as a billing and coding specialists while holding down another job gives you extra security in a questionable economy. This provides you with additional income, as well as experience for when you are ready to “solo” full time. As a medical billing and coding specialist, you have more flexibility than many other career paths might provide.
Educational Requirements for Medical Billing and Coding Specialists
Although a high school diploma is the minimal educational requirement for an entry level position, many employers look for an associate degree in medical billing and coding. Applicants who have taken courses in medical and diagnostic procedures and anatomy are preferred. Additional courses would include how to translate information into codes, a background in medical billing methods, and the use of billing and coding software. Some of these courses are available in certificate programs. A two-year study program can provide you with an Associate of Applied Science in Medical Billing and Coding degree. This degree will certainly make you marketable in the health care administrative job market. An associate degree will include general courses about the healthcare industry, terminology, medical billing and medical ethics laws. Some schools offer hands-on experience at hospitals or insurance companies. The average annual salary of a medical billing and coding specialist with an Associate’s degree is $49,769.
A bachelor’s degree is not required for a billing and coding specialist. But for those who want to advance their career and enter management, a four-year degree in healthcare management provides that opportunity. These management positions can be in hospitals, other healthcare facilities and with insurance companies. Courses covered in a four-year program are all aspects of data management, technology management, project management and statistical research methods. A bachelor’s degree will enable you to become a team leader of a coding and billing team and of a document management team. As a team leader, you will manage the team and ensure that claims are filed in a timely manner. You will train teams and review coding and billing for accuracy. You will work with the insurers and physicians to handle claim issues as they arise. Basic skills needed for a medical billing and coding team leader are:
1. Overseeing account receivable functions.
2. Handle reimbursement issues.
3. Familiarity with medical collection process.
4. Developing and improving billing procedures.
5. Working with medical staff on improving inaccurate coding procedures.
6. Being responsible for the confidentiality and privacy needs of patients.
7. Navigating various medical electronic sites to access necessary information.
8. Improving basic document management.
The average annual salary for a medical billing and coding specialists with a Bachelor’s degree is $66,000. Entering a Master of Science in Health Information Management program requires a Bachelor’s degree. The curriculum combines healthcare information and management. Courses included human resource management, different coding systems and electronic healthcare management. Top salaries for specialists with a Master’s degree can exceed $100,000.
Job Outlook for Medical Billing and Coding Specialists
The job market for specialists is growing above the national average due to a population that is aging and in need of medical care and new laws and regulations governing the healthcare industry. The market is expected to grow by 22 percent through 2022. The high demand for medical billing and coding specialists is the reason for the excellent and above-average salaries. High demand also means there are a lot of applicants after the same job. To get your foot in the door, take an administrative job in the medical field such as medical secretary or receptionist, if necessary. Once on the job, make your qualification known and offer your assistance in any billing functions. This puts you in an excellent position for any job openings.
Becoming Certified as a Medical Billing and Coding Specialist
There are medical billing and coding programs that offer basic certificates. The duration of these programs can last from six to 12 months. They all require a high school diploma. Medial staff schools, career schools, community colleges offer these certification programs, as do online programs. The cost for a certificate program will be several hundred dollars. The basic curriculum will include pharmacology, anatomy, terminology, medical and insurance billing and office management. Beyond basic certification, there are more specialized certificates for which you can apply and make yourself a more desirable job candidate. The American Health Information Management Association (AHIMA) offers certification following the completion of an association degree in medical billing and coding. If you plan on specializing in a specific medical billing and coding area, you can become certified in the following specific areas:
1. Hospitals and other medical facilities.
2. Private insurers and government insurers, such as Medicare and Medicaid
3. Radiology/Cardiovascular. This specialty pays than more than others in the medical billing and coding industry.
4. An associate degree with a background in billing, coding and medical transcription.
5. Other specialty certificates include dermatology, pediatrics, plastic surgery, general surgery, urology and family practice.
Becoming certified in a specialty area can increase your earning potential and open more professional doors. It designates you as a top member of your profession and brings you the respect that comes with it. These specialty certificates validate your career commitment and your increased knowledge of billing and coding. The American Academy of Professional Coders (AAPC) provides certificates for medical billers and coders.
Online degrees are becoming the norm these days, and taking online courses toward your medical billing and coding career is easy. Online programs offer the necessary curriculum courses for a certificate and two and four-year degree programs. For a degree, online studies are an excellent way to get a degree at your own pace, since there are few hands-on requirements. As an alternative, you could go hybrid – divide your courses between online and classrooms. Online classes have teacher-student interactions via videos. There will be homework assignments and opportunities to ask questions. The real benefit is you fit in your classes around your schedule, not the other way around. Specifically for medical billing and coding students, studies will include reading charts and making the proper diagnosis and creating proper claim files. Before decided on an online program, be sure and do your research. Any school that makes unrealistic claims and promises might be a scam. Your school should be accredited by professional organizations such as the American Health Information Management Association, the American Academy of Professional Coders, or Commission on Accreditation for Health Informatics and Information Management.
Preparing for your Medical Billing and Coding Specialist Interview
Congratulations! You have a job interview. As you would for any other interview, you should dress professionally and carry several copies of your resume. Whether you are a student looking for your first job or an experienced biller and coder, you will be asked standard interview questions relating to the position. Being prepared can put you ahead of the competition. Here are some questions you should be able to answer without hesitation:
1. Why are you interested in medical billing and coding?
2. How do you handle problems or disagreements with other people?
3. How good are you at doing detailed research?
4. What certifications do you have that relate to this job?
5. How many claims can you process each day?
6. What electronic billing systems have you used?
7. How have your dealt with rejected claims?
8. With what codes are you familiar? What specialty codes?
9. What is your experience with accounts receivables?
10. How do you organize information gathered from a number of different sources?
11. Are you familiar with Medicare and Medicaid billing process?
12. What is your background in medical terminology?
Be prepared, be enthusiastic, be hired!
If you are working from home as an independent medical billing and coding specialist, you won’t be going through the standard interview process; however, you still need to be professional. Have an area that is designated as your work space. Don’t work at the kitchen table. When meeting with potential clients, dress professionally. Have a portfolio of your work that testifies to your abilities. As a professional, you will be setting your own fees. Determine what is appropriate for your area and be firm about your own worth. The national average for a billing and coding specialist can range for $10.00 to $25.00 dollars, depending on location. Some projects may be on a flat-fee basis, so you will need to negotiate for your best interest. As you become more experienced, your fee should reflect what you have to offer to a client.