Medical billers and coders are specialized health information technicians who ensure patient care is recorded correctly for billing purposes. They may also act as a liaison between a medical facility, insurers and patients.
What does a medical biller and coder do?
- Assigns diagnosis and procedure codes to patient records.
- Bills insurance companies for patient care.
- Work with insurers to answer and resolve any billing questions.
- Maintains the confidentiality of patient records.
Where do medical billers and coders work?
About a third of health information technicians, including medical billers and coders, work in hospitals, according to the federal Bureau of Labor Statistics. Another 19 percent are employed in physician offices. However, those with medical billing and coding careers may find jobs in other places as well.
- Insurance companies may hire medical billers and coders to check claims for possible discrepancies or incomplete information.
- Law firms may rely on billing and coding professionals to interpret claims information during fraud cases.
- Government agencies need medical billers and coders for public insurance programs as well as to analyze claims data for use in health care research.
How to Become a Medical Biller and Coder
To pursue a career in medical billing and coding, you need the right education. Employers may also be looking for workers with medical billing and coding certification. Here's more on how to get both the schooling and the credentials you'll need.
- Earn a high school diploma. Some facilities provide on-the-job training to high school graduates, but it is more common to use a high school diploma as a foundation for a medical billing and coding degree.
- Complete a medical billing and coding degree program. Postsecondary training programs teach students the coding classification systems, and most result in either a certificate or a diploma. Some degree programs offer online courses for added convenience.
- Certification, licensing and exams for medical billers and coders. You won't have to worry about getting licensed by your state to become a medical biller and coder -- the profession isn't regulated in most areas -- but you may want to earn a professional certification. Below are a few examples of the types of credentials offered by industry groups.
| Certification | Certifying board/organization | Exam details | State requirements | License/certificate renewal? |
|---|---|---|---|---|
| Certified Professional Coder (CPC) | AAPC (previously known as American Academy of Professional Coders) | Proctored multiple choice exam. Score of 70% or higher needed to pass. One free retake included in exam price. | None | 36 continuing education units required every two years to maintain certification |
| Certified Professional Biller (CPB) | AAPC | Proctored multiple choice exam. Score of 70% or higher needed to pass. One free retake included in exam price. | None | 36 continuing education units required every two years to maintain certification. |
| Certified Coding Specialist (CCS) | American Health Information Management Association (AHIMA) | 97 single response multiple choice questions and 8 medical scenarios with up to 3 questions each. | None | 20 continuing education units, including two mandatory annual coding self-reviews, every two years to maintain certification. |
| Certified Medical Coder (CMC) | Practice Management Institute | Proctored exam requiring a 70% or higher score to pass | None | 12 continuing education units every year to maintain certification |
Career advancement for medical billers and coders
Some medical billers and coders may earn specialty certifications in fields such as urology or dermatology while others may return to school to advance their career. With experience or additional education, billers and coders may move into supervisory or management roles.
Important Skills and Abilities for Medical Billers and Coders
- Reading comprehension - Medical billers and coders must be able to understand chart notes in order to properly assign clinical codes.
- Critical thinking - In order to select the right code, these professionals must possess strong critical thinking skills.
- Near vision - Much of the work in this profession is done on the computer, which makes good eyesight helpful.
- Information ordering - This ability refers to a medical biller and coder being able to categorize and order information using clinical coding definitions.
- Oral expression - If an insurer or a patient has a billing question, these workers must be able to provide a clear answer.
Medical Biller and Coder Salary and Career Outlook
The following is a look at the projected career growth and income potential for medical billers and coders, per government data.
Professional Organizations for Medical Billers and Coders
- AAPC: Founded in 1988, this organization offers education, certification and networking opportunities for medical billers and coders.
- American Health Information Management Association: Known as the AHIMA, this group has been advocating for health information management professionals since 1928.
- Practice Management Institute: PMI has been offering education and certification to medical office administrative staff since 1983.
Sources:
- Bureau of Labor Statistics, U.S. Department of Labor, Occupational Outlook Handbook, Medical Records and Health Information Technicians, Accessed September 2019, https://www.bls.gov/ooh/healthcare/medical-records-and-health-information-technicians.html
- Certified Professional Biller (CPB) - Certification Exam, AAPC, Accessed September 2019, https://www.aapc.com/certification/cpb/
- Certified Professional Coder (CPC) -Certification Exam, AAPC, Accessed September 2019, https://www.aapc.com/certification/cpc/
- Where Do Medical Coders Work? 7 Settings That Might Surprise You, Brianna Flavin, December 10, 2018, Rasmussen College, Accessed September 2019, https://www.rasmussen.edu/degrees/health-sciences/blog/where-do-medical-coders-work/
- Certified Medical Coder, Practice Management Institute, Accessed September 2019, https://www.pmimd.com/onlinetraining/certification/index.php?prodID=186
- Certified Coding Specialist, American Health Information Management Association, Accessed September 2019, http://www.ahima.org/certification/CCS
- Medical Records and Health Information Technicians, O*NET Online, Accessed September 2019, https://www.onetonline.org/link/summary/29-2071.00