Medical billing and coding specialists play a vital role in the healthcare system. Their accuracy, attention to detail, and understanding of healthcare regulations help ensure that medical practices, hospitals, and healthcare facilities receive proper reimbursement for the services they provide.
Without their work, revenue flow would be disrupted making it difficult for physicians, nurses, and other providers to focus on delivering quality patient care.
Beyond supporting healthcare operations, medical billers and coders also serve as an important safeguard for patients. When billing and coding are done correctly, patients are less likely to be overcharged, billed incorrectly, or face delays caused by claim errors or denials.
In this article, we explain what medical billing and coding specialists do, what to expect from this career path, and the steps for getting started.
Job Duties of a Medical Billing and Coding Specialist
Medical billing and medical coding are closely related but distinct disciplines within the healthcare revenue cycle. Medical coding focuses on reviewing patient charts and health records, and translating clinical documentation into standardized medical codes. These codes represent diagnoses, procedures, treatments, and medical supplies or equipment provided during a patient’s care.
Medical billing, on the other hand, involves taking those standardized codes along with patient and insurance information and submitting claims to insurance companies and payers. The goal of medical billing is to ensure healthcare providers receive accurate and timely reimbursement for the services they deliver.
A medical billing and coding specialist performs both functions. In this combined role, the specialist analyzes medical records to assign the correct codes and then uses those codes to prepare and submit insurance claims, resolve claim issues, and support the reimbursement process from start to finish.
Medical billers and coders are also generally responsible for following up on claims, handling claim denials, and managing patient billing and collections for balances not covered by insurance. Medical billing and coding is essential for effective revenue cycle management within a healthcare business or organization.
For more of an overview, common medical billing and coding specialist job duties include:
- Verifying patients’ insurance and obtaining pre-authorizations prior to care
- Answering patients’ questions regarding costs of care, explanation of benefits (EOBs), and billing
- Translating complex clinical documentation into universal codes (such as CPT, ICD-10-CM, HCPCS, and ICD-10-PCS)
- Using medical codes, patient details, and insurance information to create and submit insurance claims
- Ensuring all claim documentation is accurate to help prevent delays or denials
- Following up on pending claims, addressing rejections, and appealing denials as needed
- Billing patients, processing payments, and setting up payment plans
- Managing accounts receivable and generating billing reports
- Reviewing medical records for completeness, accuracy, and compliance with HIPAA (Health Insurance Portability and Accountability Act), HITECH (Health Information Technology for Economic and Clinical Health Act), CMS (Centers for Medicare & Medicaid Services) regulations, OIG (Office of Inspector General) compliance guidelines, and other applicable federal and state healthcare laws and privacy regulations
Where Do Medical Billers and Coders Work?
Medical billers and coders can work for any company, organization, and agency that would need to file, process, or investigate medical insurance claims. This can include a variety of settings, including but not limited to:
- Physician’s offices
- Healthcare clinics
- Dental offices
- Hospitals
- Healthcare systems
- Outpatient care centers
- Long-term care facilities
- Government agencies
- Educational institutions
- Insurance companies
- Healthcare consulting agencies
- Law firms
- Home health agencies
- Radiology facilities
- Medical billing and coding service providers
Some roles may require on-site work while others may be remote positions. However, keep in mind that your first year as a medical billing and coding specialist will likely involve in-person work as you gain a deeper understanding of the profession.
What Hours Do Medical Billers and Coders Work?
Typically, medical billing and coding jobs offer full-time work during standard business hours (such as Monday through Friday, 8 a.m. to 5 p.m.). In general, medical billers and coders do not work overnight hours as insurance companies and other billing offices are closed.
What Skills Do Medical Billing and Coding Specialists Need?
To be an effective medical billing and coding specialist, you should have the following skills:
- Medical knowledge, specifically understanding of medical terminology and human anatomy
- Technical expertise, specifically pertaining to standardized medical codes, medical coding software, and electronic health records
- Attention to detail to help ensure accurate analysis of clinical documentation and preparation of insurance claims
- Problem solving, which is especially important when addressing rejected or denied claims
- Effective communication for answering patients’ insurance coverage and billing questions, and for talking through issues with payers
- Ethics, as medical coders and billers have a duty to present accurate claims and protect patient confidentiality
What are the Advantages of a Medical Billing and Coding Career?
People pursue medical billing and coding careers for many reasons, including the following.
Quick entry into the field: Healthcare organizations typically require completion of a certificate or diploma program in medical billing and coding for this role (instead of a degree) along with professional certification. Completing this type of program can cut your education time down from years to months.
Scheduling and job flexibility: There are medical billing and coding jobs that are available as part-time and/or remote roles, which can provide increased flexibility and work-life balance.
Diverse work settings: From private practices to major hospitals and healthcare systems, there are a vast array of employment opportunities for medical billing and coding specialists. They can even work for employers that are not healthcare providers, such as law firms or third-party medical billing and coding companies.
Opportunities for career advancement: Expertise with medical terminology, health insurance codes, and medical billing best practices provides a strong foundation for individuals who are interested in advancing to other roles in the future, such as coding managers, coding auditors, compliance specialists, healthcare administrators, and more.
Ability to make a difference: Medical billing and coding specialists play a major role in helping healthcare offices and organizations sustain their revenue flow and therefore maintain their financial health — which means they’re better positioned to deliver quality care to patients. These specialists also help ensure patients are properly charged for their care and can assist them with questions related to their insurance coverage and billing, which can result in a better patient experience.
How to Become a Medical Billing and Coding Specialist
To get started on this career path, you will need to complete a medical billing and coding program. If you’re interested in the dual title of “medical biller and coder” rather than a role that focuses on just one discipline, it will be important to complete a program that covers both areas of the profession. It’s also helpful to obtain professional certification, as it is often required or preferred by employers.
American Career College offers a 100% online Medical Billing and Coding Specialist program, which helps you earn your diploma in less than nine months while gaining real-world experience through a 130-hour online practicum. Additionally, the program prepares students to sit for the Certified Professional Biller (CPB) exam.
Learn more about becoming a medical billing and coding specialist in our career guide and explore ACC’s Medical Billing and Coding Specialist program.
