Medical Billing and Coding Specialist

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How to Become a Medical Biller and Coder?

Medical billers and coders work at healthcare centers. Every procedure that takes place is recorded in patient files, which is then translated into codes and used to submit claims to insurance companies. To become a professional medical biller and coder, you must first ensure your eligibility by determining whether this is the career you want and by acquiring a high school diploma or equivalent in order to enroll for a medical billing and coding program. Even though graduating from the program isn’t necessarily required, but it could increase your job prospects.

After obtaining a degree in medical billing and coding, you may also take certification exams such as CPC, CCS, to make yourself more favorable to employers. With all these qualifications, the next step for you is to land your first job as a professional medical biller and coder.

What is Medical Billing and Coding?

Medical billing and coding is a process of analyzing patient data such as procedures, treatment records, and insurance information, followed by transcribing the data into standardized codes to bill insurance companies. Medical billers and coders work for the healthcare facility to receive proper reimbursement for the services that are provided by them.

Medical coding is the process of translating medical information into codes by using coding systems such as ICD-10-CM and HCPCS level 2. These codes are used to review medical services and reports. At the same time, medical billing is the process to bill the health insurance companies by submitting medical claims and then following up on to received payment for the services offered.

Is Medical Coding Different From Medical Billing?

Both medical coders and medical billers are familiar with medical terminology, and they work together to receive reimbursement for the healthcare facility. But they both are also quite different from each other in terms of their job description.

Here are a few differences:

  • Medical coders have to process medical data into standardized codes using classification systems to categorize treatment records, diagnoses, and procedures. In contrast, medical billers submit invoices to health insurance companies and follow up to receive reimbursement.
  • Medical coders use Electronic Health Records (EHR) and Electronic Medical Records (EMR) software to process data, whereas medical billers generate claims from the codes and manage invoices. They also analyze denied claims to find faults and revise them.
  • Medical coders work alongside physicians and healthcare officials, whereas medical billers work with patients and health insurance companies.

How Long is Schooling?

Medical billing and coding training programs are offered across all the states by accredited colleges. These programs can be categorized into certificate, diploma, and associate degree level programs. To pursue postsecondary education in medical billing and coding, a candidate must be a high school graduate. Apart from the theory and hands-on laboratory experience, some of these programs also prepare candidates for certification exams.

Although some candidates prefer the work experience route rather than the training program, a candidate is more preferred by the employers after obtaining education qualifications.

Certificate and diploma programs can be completed in less than a year, yet the duration depends on the specific college. Such programs usually consist of 30-40 credits. The associate degree is denser and has a more concentrated curriculum compared to the latter. The program has approximately 60 credits in the coursework and can be completed within 2 years.

Medical billing and coding programs can also be completed online at the same duration as traditional programs. Some online courses can be completed within 6 months and are offered by accredited schools.

How Much does it Cost to Get Certified in Medical Billing and Coding?

Medical billing and coding programs have an average cost range of $2,500-$6,500. Certificate programs may cost $1,500-$3,000, whereas diploma programs cost approximately $4,200-$6,400. Associate programs are lengthy and thus have a higher cost range, between $8,000 to $16,000.

Taking certification exams accredited by AHIMA, AAPC, etc. may also cost you around $199-$399. Candidates may also apply for financial aid, grants, and loans to afford the cost of attendance.

Types of Medical Billing and Coding Certifications

Certifications for medical billers and coders are preferred as they offer credibility to trained professionals in the field. Employers tend to hire people who are qualified to do every possible task at hand. The certifications allow the candidates to perform specialized tasks. Below stated are some of the most sought after certifications.

  • Certified Billing and Coding Specialist (CBCS)

CBCS is a credential offered by the National Healthcare Association (NHA). To become a certified billing and coding specialist, a candidate must be eligible to fulfill specific prerequisites such as:
a) obtaining a high school diploma or equivalent
b.1) completing a medical billing and coding training program within the past 5 years
b.2) working as a medical biller and coder under the supervision of a recognized physician/healthcare facility for at least a year.
The CBCS certification must be renewed every 2 years. The exam consists of 100 questions, and the candidate must pay an examination fee of $117 to register for the exam.

  • Certified Professional Coder (CPC)

CPC  is a certification accredited by AAPC. This credential is considered as the gold standard for physician-based medical coding. The certification exam consists of 150 questions covering 17 different areas of knowledge. The exam is carried out as both physical location proctored and online proctored. To be eligible to take the exam, an associate degree in medical billing and coding is recommended (not required). The certification must be renewed every 2 years. The examination fee is $299 (online proctored exam) and $399 (physical location proctored exam).

  • Certified Coding Specialist (CCS)

CCS is a certification exam accredited by AHIMA. It is an advancement for experience inpatient/outpatient coding professionals. The exam consists of 97 questions. To take the CCS exam, the candidate must either complete courses in the following topics: anatomy & physiology, medical terminology, pharmacology, reimbursement methodology, CPT coding, etc. or must have a minimum of 2 years of related coding experience. The credential must be recertified every 2 years by earning enough continuing education units. The examination fee is $299 for members and $399 for non-members.

  • Certified Medical Coder (CMC)

CMC is a certification exam offered by Practice Management Institute (PMI) and is designed for medical coding professionals that work with outpatient claims. The exam consists of 133 questions and needs at least 70% to pass. The candidate must have work experience as a medical coder for a minimum of 1 year. Recertification is required annually by earning 12 continuing education units. The cost of CMC certification training is $1250. Exams are proctored live in testing centers across the country.

  • Certified Outpatient Coder (COC)

The COC certification exam is accredited by AAPC. COC credential shows proficiency in assigning codes in the outpatient setting. The exam consists of 150 multiple-choice questions. An associate degree in medical coding is recommended. The exam covers topics such as anatomy, medical terminology, CPT, ICD-10-CM, etc. A score of 70% must be maintained to pass the exam. The certification must be recertified every 2 years by completing 36 continuing education units (CEU).

  • Certified Professional Biller (CPB)

CPB is a certification exam offered by AAPC. The CPB certification exam prepares medical billers to perform billing tasks and to maintain various aspects of the revenue cycle. The examination consists of 200 multiple-choice questions. The certification exam covers topics such as billing, coding, reimbursement & collections, and types of insurance. An associate degree is recommended but is not required. An overall score of 70% or higher must be obtained to pass the exam. The CPB examination fee is $399.

What are the Education and Training Requirements?

Education 

To become a professional medical biller and coder, a candidate must obtain a high school diploma or equivalent and further must acquire postsecondary education in the field. Candidates enroll themselves in medical billing and coding training programs to pursue associate, certificate, and diploma courses.

These programs will train candidates in CPT, ICD-10-CM, HCPCS, coding systems, and specialized areas such as anatomy, medical billing, etc. These programs also include hands-on training experience for potential medical billers and coders. Candidates must complete the program to become a medical biller and coder.

On Job Training

For achieving the CBCS certification, the candidate must have work experience of at least 1 year in the field under the supervision of a healthcare facility within the past 3 years. CPC aspirants must have at least 2 years of on the job medical coding experience. For the CCS certification, the candidate must have 2 years of related coding experience in directly applying codes. Documents showing proof of on the job training must be submitted.

Certification Exam

Certification exams, such as CPC, CCS, CPB, and CBCS, prefer candidates with postsecondary education in medical coding and billing from an accredited college. An associate degree is highly recommended. Exam format usually includes multiple-choice questions. Certain exams are proctored through online mediums as well as through practical exam centers. The number of items ranges from 100 to 200.

How to Choose the Right Medical Billing and Coding Program: Find the Right School

To find the right medical billing and coding program, you must first determine your eligibility by going through the eligibility criteria of the potential colleges that are offering programs. Choosing the correct degree is also essential. It’s important to know whether you want a quick certificate program or an in-depth associate degree.
The cost of the school varies according to the institutes, and finding a college with affordable tuition must be your priority. To afford the program, you may also apply for financial aid, grants, loans. Thus, you must check whether the college provides any financial assistance or not. A college accredited by a recognized board must be highly considered.

Can you Pursue Medical Billing and Coding Online?

A degree or an official training program is not required, but by pursuing postsecondary education in medical coding and billing, employers will see your dedication towards the field, and this might elevate your chances of getting hired. Although traditional courses are offered by many private and public schools, online medical coding and billing programs are also provided for students’ convenience. These online courses are flexible, and some are even self-paced (asynchronous), which will allow you to learn at any time and pace you want.

Online programs cost roughly the same as traditional ones and are accredited by recognized boards such as AAPC and AHIMA. Lots of students are opting for online learning as it is a very convenient option for those who work part-time or have families to support. Some courses are offered entirely online, and some are also offered as hybrid programs to provide a hands-on learning experience with online training. Students graduating from online and traditional medical billing and coding programs have the same job opportunities and career aspects.

10 Reasons to Become a Medical Biller and Coder

A medical biller and coder is a rewarding job. The shifts are flexible, the job is meaningful, and the prospects are remarkable. Here are some reasons to consider medical billing and coding as your career path.

  1. Convenient Learning Options

    To acquire formal education in medical billing and coding, candidates choose from varied programs that offer online learning as well as traditional learning. These programs are accredited by authorized institutes.

  2. Quick Credentials

    Working in the medical field often requires years of education, but as a medical biller and coder, you need as little as 6 months to complete a course.

  3. Better Job Prospects

    Medical billers and coders have an impressive job growth rate, which is estimated to increase by 11% from 2018 to 2028. Thus, with more job growth, there will be more employment security.

  4. A Self-fulfilling Job

    Working in the healthcare field is gratifying, and it also earns respect in the community. Apart from that, helping patients by managing their invoices and providing them reimbursement is genuinely satisfying.

  5. Appealing Income

    The average medical biller and coder salary is projected higher than the average US income. Much higher pay is expected with more work experience.

  6. Flexibility

    As technology is getting more advanced, medical billers and coders are allowed to work more flexibly from home or by following the schedule as per their convenience. A 9 to 5 plan is not mandatory, and they can choose to work in different shifts.

  7. Freelancing

    As the possibilities of working from home are getting more real, medical billers and coders are opting to do freelance work. It allows them to work for an out of state healthcare facility.

  8. Certification Earns More Benefits

    Being certified as a medical biller and coder can contribute to the overall credibility and can also increase the chances of getting hired. A valid certification can lead to a much nicer income.

  9. New Career Possibilities

    The job in the sector may lead to other administrative job profiles. The experience gained may help you start a different career path.

  10. Different Work Environments

    Medical billers and coders have multiple work environments to choose from. They can work in hospitals, clinics, outpatient care centers, nursing homes, insurance companies, etc.

Medical Billing and Coding Job Duties

Medical billing and coding specialists work in healthcare settings and ensure proper reimbursement to the medical facilities. These professionals work alongside physicians and other health specialists. Medical coders have expertise in coding systems and are responsible for applying codes by reviewing patient information. In contrast, medical billers are responsible for creating medical bills and following up to gain proper compensation for the services that have been provided. Medical billers are skilled in billing regulations, revenue cycles, coding, different types of insurances, etc.

Job duties of a medical biller include:

  • Submitting medical claims to health insurance companies for reimbursement
  • Following up with insurance companies for medical bills
  • Preventing insurance fraud by accurately auditing bills and claims
  • Using codes efficiently to create medical bills

Job duties of a medical coder include:

  • Assigning standard alphanumeric codes for diagnosis, treatments, and procedures
  • Reviewing patient information to apply codes
  • Acquire proficiency in ICD-10-CM, CPT, HCSPCS code systems
  • Preserving patient information for confidentiality and security purposes

Future Demand and Job Outlook for Medical Billers and Coders

According to the US Bureau of Labor and Statistics (BLS), the employment for medical records and health information technicians is likely to grow at the rate of 11% from 2018 to 2028, with an expected change of 23,100 new jobs during this period. These high job prospects are attained due to the aging of the baby boomer population and their need for better medical services.

As medical services increase, the healthcare centers will need more medical coders and billers to gain reimbursement from insurance companies. The Electronic Health Records (EHR) systems are getting familiar and need medical coders to use them. Medical billers and coders with authorized certifications are more likely to achieve better job prospects.

How Much Does a Medical Biller and Coder Make?

For a profession that requires minimum education prerequisites, medical billing and coding specialists earn a very generous income. As per the BLS, the mean annual wage for this job is $46,590, and the mean hourly salary is $22.40, as of May 2019. BLS has covered the employment and income statistics of medical billers and coders under the umbrella category of medical records and health information technicians that also includes other occupation statistics such as medical dosimetrists, medical records specialists, health technicians, etc.

According to indeed.com, however, the average hourly salary of a medical biller has been stated as $16.37 per hour.

Estimated Salary for Medical Billers and Coders by Highest Employing Industries

IndustryEmploymentHourly Mean WageAnnual Mean Wage
Hospitals115,760$23.74$49,370
Offices of Physicians51,890$19.95$41,500
Outpatient Care Centers49,980$20.95$43,570
Management of Companies and Enterprises13,610$24.15$50,230
Nursing Care Centers10,570$19.96$41,520

Source: BLS (as of May 2019)

General medical and surgical hospitals offer the highest levels of employment. The industry has an employment number of 115,760 for the medical billing and coding occupation. Management companies being in the league of most employing industries offer the highest annual mean salary of $50,230 to medical billers and coders. Statistics show that solo practices, such as clinics, are comparatively offering small packages than the large scale settings, such as hospitals and companies.

Top Paying States for Medical Billers and Coders

StateEmploymentHourly Mean WageAnnual Mean Wage
District of Columbia1010$28.58$59,450
Alaska1040$27.89$58,000
Hawaii1070$26.41$54,920
Massachusetts7930$26.14$54,370
Washington8650$25.91$53,890

Source: BLS (as of May 2019)

As per this table, we can say that the District of Columbia offers an annual mean salary of $59,450, which is the highest paying state, among others. Washington provides the highest employment rate while being the lowest paying state, among others. Yet, the mean salary offered in the state is much higher than the median salary of $42,630 for medical billers and coders.

How to Find a Medical Billing and Coding Job?

To land your first job as a medical biller and coder, you may take assistance from placement services offered by the colleges. The alumni network of the college you are trained from may also get you employed. Other than these services, you may also go through online websites that offer various job postings.
Here are some job sites you may refer to:

  • Indeed: Indeed is a globally recognized employment search engine. The website provides job listings for various professions and has an impressive filter system.
  • LinkedIn: LinkedIn is an online website where recruiters post job listings, and job seekers post their CVs. It is an excellent platform to network.
  • Health eCareers: Health eCareers is a website that forms an exclusive network for healthcare professionals and employers.
  • KForce: This is one of the leading award-winning staffing service providers in the US, located physically in 60 plus major cities. The agency recruits professionals from technological, accounting, government, and healthcare backgrounds.
  • Career Vitals: Career Vitals is an online website that recruits healthcare employees. It critiques your resume and also provides job alerts for better job possibilities.
  • AAPC: AAPC offers employment listings for medical billers, coders, and other allied health professions.

Career Advancement for Medical Billing and Coding Specialists

Medical billing and coding specialists work in the administration sector of the healthcare system. These professionals acquire their job position by either education prerequisites or by work experience prerequisites. Some other allied healthcare occupations possess similar job duties as that of medical billers and coders. These occupations can be career advancement opportunities for healthcare professionals.

Some career advancement occupations for medical billers and coders are:

  • Medical Records Technician
  • Medical Billing Manager
  • Health Information Specialist
  • Medical Records Analyst
  • Medical Records Director
  • Medical Records Administrator
  • Health Information Clerk

Recertification Requirements

Recertification is required to maintain the validity of the credential. The recertification process primarily comprises of completing continuing education requirements in a given period. The NHA certification (CBCS) must be recertified every 2 years by submitting documents showing the completion of a minimum of 10 continuing education credits.

The AAPC certification (CPC) must be renewed every 2 years by completing 36 continuing education units (CEU). The AHIMA certification (CCS) must be renewed by completing 20 CEU within the recertification cycle of 2 years.

Resourceful Links for Medical Billers and Coders