Medical Insurance Billing and Coding, How To Get Started

When a person avails the services of a health care provider, relevant data is gathered about the services rendered, and sent to the patient’s insurance company to recover the payment. This bill will include information regarding the diagnosis, treatments, and other procedures done by the doctor. Millions of such bills are generated all over the country, and hence this information has to be presented in a standardized coded structure for the sake of brevity, and ease of feeding the data into computers. Based on these codes and the patient’s health plan, the insurance company will decide, how much has to be paid to the health care provider.

Who is Responsible for Medical Insurance Billing and Coding?

The job of billing and coding is highly skilled and responsible task, which is performed by qualified personnel. Billing and coding are two distinct specialist tasks, however, in most small offices both these functions are performed by a single person. Billers and coders usually have to work together for the smooth functioning of the whole process.

medical insurance billing and codingThe medical biller is involved in making sure all patients are billed correctly, and the payments are being received in time from the insurance companies. Hence, their job also involves interacting with the insurance companies and the patients. The biller should be able to understand the information on the invoices, and know the meaning of the codes.

On the other hand, medical coders are only involved in analyzing the medical information, and converting this information into code. Every form of medical information such as diagnosis, procedures and treatments, has a code assigned to them, and the coder is responsible for giving the correct code to each type of information.

How to become a Medical Insurance Biller and Coder

Specialized training is obviously required to perform this job, and there are many institutions providing certified courses. Certification is not mandatory to get a biller and coder job; however, job prospects are greatly enhanced when the candidate has acquired training, and cleared a certification exam. Certification also increases the earning potential of the candidate. According to statistics, a person having CPC (Certified Professional Coder) credentials will be earning 20% more than candidates who do not have any certification.

While selecting a training course look for a program that provides training in medical terminology, evaluation of medical documentation, billing software, and government programs. A good program will provide practical training in preparing insurance claims, electronically and manually, and will teach you documenting and interviewing skills.

Apart from private courses and programs, there are national organizations that offer popular certification courses. The most famous ones are –

  • AAPC (American Academy of Professional Coders): This organization provides certification in CPC (Certified Professional Coder) in areas like outpatient facility/hospital, physician practice, interventional radiology and cardiovascular and Payer.
  • AHIMA (American Health Information Management Association): AHIMA provides certification as CCA (Certified Coding Associate), and CCS (Certified Coding Specialist).
  • PAHCS (Professional Association of Healthcare Coding Specialists): PAHCS offers specialization in coding in different medical specialties like mental health, family practice, basic medical and so on.
  • BMSCC (Board of Medical Specialty Coding and Compliance): This is a board that provides SCP (Specialty Coding Professional) and ACS (Advanced Coding Specialist) credentials in various medical areas such as urology, orthopedics, emergency medicine, anesthesia and more.

Apart from training and certification, a candidate will also require some basic skills. These include basic math, typing, and data entry skills. The person will also need working knowledge of office software like a spreadsheet, word processor, and email client. Candidates should also possess good communication skills, as they have to interact with patients and insurance companies.

Qualifications Needed

Each program or organization that provides certification course will have its own set of requirements. Some may need direct field experience and/or post secondary education. The level of stringency in the certification exam will also differ between institutions, and the course that is chosen. Exam fees for popular certifying exams like CCA and CPC are quite costly, and hence a candidate should acquire adequate training and experience before attempting such exams. Many schools, apart from imparting excellent training, also provide internship programs for their students, to gather experience.

Working Conditions

Billers and coders usually work in health care facilities and private practices in an office setting. The size of the establishment where you find work, will mainly determine your responsibilities and working conditions. In most small sized facilities, the person will have to take care of billing and coding duties, along with reception work, and interacting with patients. The working hours is usually the typical full time, 40-hour week, however, there are part-time positions also available.

Earning Potential

The starting salary for a medical insurance biller and coder is $21,321 per annum. With experience, the salary will rise to $41,133, and the top 8% get $51,510 per year. The hourly rate for this profession is in the range of $10.16 to $18.23, with overtime in the range of $17.15 to $28.87. People working in doctor’s office or hospital will be eligible for the respective benefits and medical insurance.

Medical Insurance Billing and Coding Job Prospects

Medical insurance billing and coding offers good career prospects, and scope for advancing in this field. With the increasing aging population, health care industry is thriving, and there is a growing need of certified professionals. In this decade, the need for professionals in this field is expected to grow by 20 percent. Secondly, there are frequent changes made in coding, and hence most health care establishments prefer candidates who have received training in the latest coding procedures. This means, even candidates who have been certified earlier, have to keep up with the changing procedures.

Leave a Comment