Medical Billing & Coding Job Description 2023

Billing & Coding Continues to Evolve

Medical billing and coding is a growing field in the health care industry. Medical billers are responsible for providing billing services, so the health care provider gets paid for the medical services rendered.

Medical billers are also responsible for the accurate flow of information between doctors, patients and third party billers. The medical biller enters the information into a database using the appropriate protocols and billing procedures.

Billing vs Coding: What's the Difference?

Medical coders will first take the data about a patient's visit, and interpret that data into specific codes. The two most common medical codes include ICD-10 codes(International Classification of Diseases, Tenth Revision), and the CPT codes(Current Procedural Terminology).

Medical billers, on the other hand, take the information provided by the coders to make payments to accounts, and to file for insurance claims. Many billers work directly with insurance companies to work out accepted/rejected paperwork, and send out invoices.

With all of that said, many certification programs teach BOTH medical billing AND medical coding. Some employees work on both, while others may work only with billing OR coding.

Job Responsibilities of a Medical Coder/Biller

The medical biller is responsible for sending the bills to the appropriate insurance carrier for payment. The insurance carrier both approves the claim and reimburses the health care provider.

If the claim is denied, the medical biller must investigate the rejection and verify the information with the provider. The medical biller updates the information and resubmits the claim for further consideration or sends the patient the bill.

Medical billers are also responsible for dealing with collections and insurance fraud.

Medical billing and coding specialists are employed by a number of facilities and work in a variety of office settings. Most medical billers work in hospitals, but there are opportunities in clinics, nursing homes, private medical practices, mental health institutions and government agencies.

Many Employees Now Work Remotely!

The field of medical billing and coding is one field in the healthcare world where employees can remotely as long as the necessary resources are available. As long as a computer, telephone, software and the necessary documents are in place, the medical billing and coding office can be anywhere.

Medical billers work with insurance companies, healthcare providers and patients, and provide accurate billing information.

Communication is often virtual, email and text rather than face to face. Medical billers can expect to work a 40 hour work week with some overtime and weekend work.

Skills Needed

Along with proper training in medical billing and coding, the medical biller should be a self motivated self starter with a lot of self discipline, especially if the desire is to start a home business. The medical biller must be very organized and attentive to details as the job entails working with documents and patient files. Medical billers must possess impeccable communication skills both written and verbal.

When dealing with medical files, there is no room for errors. Errors, even the minutest, can disrupt the entire billing system. Another aspect of medical billing is confidentially with regard to the information provided. Files in the medical biller’s possession must be kept from public view in a secure manner. This is especially important if the medical biller is working from a home office.

Technically, there are no set training requirements for the job, but the vast majority of employers are going to require certification from an accredited program.

Skills taught in medical billing will cover medical terminology, anatomy, physiology, diseases and diagnosis. This knowledge base is crucial for the coder who has to translate medical terminology into the appropriate medical code.

Medical Billing And Coding Schools

The ability to take classes either entirely online, or in a "hybrid" environment has opened the door to education for a larger student population. The ability to take classes according to your own schedule than rather than an established school schedule has made the education process more convenient.

Because of the demands placed on individuals today with family and work responsibilities, it is difficult to take on something like school and fit it into an already busting at the seams schedule.

Colleges And Universities

Most colleges and universities, as well as, community colleges, technical schools and vocational training schools also have a web based program of classes in addition to their standard class curriculum that meets in a campus based educational atmosphere.

There are some schools that are strictly web based and do not have a physical location except for administrative offices. Online classes are accredited the same as traditional educational programs as well as prepare the student for any professional certifications or licensing necessary in that field.

The student taking online classes can earn certificates, diplomas and degrees, such as an Associate and Bachelor's degrees. The online classes can also serve as the necessary continuing education credits necessary to maintain professional licensing and certification.

American Academy of Professional Coders

The American Academy of Professional Coders, or AAPC, was begun in 1988 to provide professional certification through education to medical coders and to upgrade the standards of medical coding by providing training, certification and job opportunities as well as net working.

The AAPC boasts a membership of more than 100,000 worldwide and more than 64,000 of those members are certified.

The AAPC medical billing program is an entry level study course geared to providing the latest and up to date information related to third-party billing and Medicare.

Specifics about the health insurance industry and the proper reimbursement methods for claim submission are the main focus for the student. Completion of the program will prepare the student to work as a medical biller in a Doctor’s office or similar healthcare facility.

Medical Billing Home Study Class

The AAPC medical billing home study class provides the student with a workbook and text book, audio lectures contained on 16 modules, and each contain a review test and final exam.

The student who completes the program successfully is awarded a Certificate of Completion. The program is also approved for 40 Continuing Education Credits, CEU’s, for certified AAPC members.

The program must be completed within a 4 month time frame. Extra time can be purchased for a small fee per month. AAPC will not grant credit and reduce the number of study hours for previous training or education. The completion of the program also qualifies for college credit at the University of Phoenix.

There is no classroom attendance, and the study schedule is entirely up to the student, however, if one module per week is completed, the program will be completed within the required time frame. Students have the option to email questions regarding the course content to the AAPC coaching staff. Students must achieve a grade of least 70% to pass the course.

What Factors Determine Salary?

Level Of Training

The demand for well trained medical billing and coding specialists will often have an effect on the salary paid for this phase of health care. The work is technical in nature, as is a need for billers & coders to be attentive to detail as well as have a thorough understanding the billing process.

That level of understanding comes from education, certification, and job experience. Those are the three biggest factors that will affect salaries. How well the certified specialist does their job and how well they understand the numbers.

In addition to billing, the medical billing and coding professional must have the know how to settle disputes when they arise.

Geographic Location

Also affecting the salary paid to a medical billing and coding clerk is geographic location, the facility where the clerk works and supply and demand.

As a general rule of thumb, facilities in and around major metropolitan cities have a higher cost of living and command higher pay rates than cities in the suburbs or rural, where the pay rate will be lower.

A larger facility will often require more billing services than a smaller facility based on work load alone. The larger facility will often hit the top of the pay spectrum while the smaller facility will hit the lower end of the pay spectrum.

Supply And Demand

Supply and demand will affect salary at odd times and not necessarily when economic conditions are good. The more demand there is for a skill and the less people there are to provide that skill, will raise the salaries to an attractive level where people will want this job.

In 2022, the average salary for certified medical billing & coding specialists was $62,580.

Alaska and California continue to be the highest paying with starting salaries of $67,260 and $65,300, respectively.