Overview Of Medical Billing And Coding Career

Individuals looking for a challenging and rewarding job in the medical field should seriously consider medical billing and coding positions. The healthcare sector is a recession-proof industry, and the demand for professionals in this field is growing as years pass.

Nurses, respiratory therapists, medical technologists, and doctors aren’t the only professionals that can make use of the many job opportunities that health care facilities offer. There are also administrative positions that need to be filled up by hospitals, doctor’s clinics, and health insurance companies.

For those who are looking to take advantage of the profitability of working in a medical field; people who are less passionate about clinical work but are highly driven in the administrative setting, a medical biller or medical coder position will definitely suit you best

By definition, medical billing is the organized system of documentation billing, and acquisition of payments for health care procedures, services, and products. The billing and coding department facilitate the processing and streamlining of collecting payments on behalf of a medical institution.

Clearly, this job is important as it brings in the revenues and profits for the hospital and the countless professionals working under the medical institution. Further, these professionals also act as patient advocate as accurate billing can mean saving patients hundreds or even thousands of dollars in out-of-pocket expenses.

Medical Coding

Medical coding is a work-related task that entails a medical coder to utilize and classify thousands of codes for procedures, services, and products. They work for hospitals, various health care settings, and health care agencies.

In order for coders to input the correct set of information on a database, he needs to have extensive knowledge in the following areas:

  • Fundamental medical office management and administration
  • Familiarization of medical and insurance terminologies
  • Standard coding protocol
  • Data-entry knowledge and software
  • Health information management

They are responsible for collecting the information of patients after the medical intervention and management process. They are also tasked to read through doctor’s documentations and other forms that are made by other members of the heath care team as well. Once the information is properly coded, they are then typed into a database. Once all data are properly coded and transcribed, they are then forwarded to insurance companies.

These tasks may seem easy for some, but it is a complex and sophisticated job as encoders are expected to be familiar with more than 16,000 codes and are deemed to use various medical coding software and database to perform their job well.

Medical Billing

Billers facilitate the sending of coded entries and information to insurance companies. They verify and check the bills that have been created by medical coders. It is quite common that billers also perform the coding process, as these personnel are known to have a firm grasp on the allocation of codes to corresponding healthcare procedures and services.

They are also responsible for following up on claims that have been issued by the health care facility. They are also responsible for ensuring that both patients and insurance companies are billed accordingly for the services that have been rendered. Lastly, a billing specialist is also responsible for investigating rejected claims and making revisions for eventual approval.

Requirements for this position include complete knowledge and understanding of the following concepts:

  • Health insurance and claim forms management
  • Medical documentation
  • Billing management
  • Electronic data interchange and modifiers
  • ICD-9-CM coding
  • Health insurance policies
  • Healthcare laws and ethics
  • Education, Training, and Certification Programs

In order to become an eligible medical coder and/or medical biller, an interested individual needs to undergo extensive education and training. There are educational institutions and agencies that offer medical assistant courses and programs. There are schools which offer diploma programs in this field. These educational programs can be completed in as short as 6 months up to 12 months. The diploma courses for these programs are quite flexible as students are given the chance to choose from daytime or night classes.

Basic subjects that are taught in training programs are as follows:

  • Biology
  • Anatomy and physiology
  • Typing and keyboarding
  • Bookkeeping
  • Mathematics
  • Basic healthcare
  • Health information management
  • Office administration
  • Patient communication and customer service skills

Getting Certified

After graduation from a training program, graduates can apply in hospitals and various health care settings. However, it is recommended that graduates take certification exams before attempting to enter the workforce.

Although health care facilities do not have certification requirements in place, it is almost and always certain that these organizations prefer those who have passed certification exams from the following professional organizations:

  • American Health Information Management Association (AHIMA)
  • Registered Health Information Association (RHIA)
  • Registered Health Information Technician (RHIT)
  • Professional Association of Health Care Coding Specialists (PAHCS)

These reputable organizations provide examinations to graduates of training programs. Those who successfully pass the certification exams are given certificates to signify that they are knowledgeable and highly skilled to perform the functions, duties, and responsibilities of a medical billing and coding professional.

Coders and billers with certification are given priority during the application process and are offered higher salaries than those without certificates.

Continuing Education

The concepts and technologies in the realm of this industry change through the years. This makes it necessary for professional billers and encoders to attend workshops, webinars, seminars, and continuing education classes to become updated with their expanding tasks in the administrative health care setting.

Continuing education courses and programs are not mandatory, but are considered to be credentials by health care organizations. Aside from the added knowledge, training, and experience from continuing education programs, participants absolutely benefit from the higher financial compensation that is given to them by their employers.


According to the latest report from the American Association of Professional Coders (AAPC), those who hold certification in this field generate $35,000 to $50,000 salary per annum. Entry-level billers and coders receive $20,000 as average salary during their first year at work. With continuing education and certification from professional organizations, the financial compensation increases substantially on the long haul.

There is a lot of room for growth and advancement in this field. Professionals with years of experience under their belt can render their services as consultants and advisors while some build independent companies as well.

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