How to Become a Certified Medical Biller
Medical billers are integral members of the healthcare industry revenue cycle management (RCM) team. A skillful biller helps healthcare facilities, insurance payors, and patients navigate the complexities of the many laws, regulations and guidelines related to the business side of healthcare. In addition to the prospects of playing an important role in the industry, another attractive aspect of the medical billing career path is that it offers challenges and opportunities for advancement without long years of schooling.
Medical billers review hospital and patient records, calculate charges, examine and submit claims, answer patient questions, and manage payments and remittances. Medical billers may concentrate on a single aspect of RCM, such as claims submission, accounts receivable, or customer relations; or they may act as generalists, handling many or all RCM duties.
Certified medical billers work in an office environment in a variety of clinical and non-clinical settings, including hospitals, nursing homes, physicians’ offices, rehabilitation facilities, insurance companies, and third party billing/consulting services. The federal and state governments also employ a large number of medical billers to handle Medicare and Medicaid claims.
Much of a biller’s time is spent in computer work or telephone communication. Most billers work full time, although job hours are flexible. Some develop their own businesses so that they can work independently from home.
Education, Training and Certification
Medical billing is a robust career field that is generally open to those with a high school diploma or equivalent GED certificate. However, many employers have begun looking only at candidates who have certification. Medical billing courses are independent of standard degree programs and may be presented in a classroom or online format. These programs usually take months rather than years to complete. Expect to learn basic medical terminology and diagnosis, procedure, supply, and medicine codes. You will also be introduced to the many and complex laws and regulations governing healthcare business, including the Health Insurance Portability and Accountability Act (HIPAA), the Affordable Care Act (ACA), Stark Laws, the False Claims Act, and the Fair Debt Collection Act.
When selecting medical billing courses, choose those offered by an accredited organization that has a strong history of training medical billers. The program should prepare you to pass one of several available medical billing certification exams. If you are thinking about a career in billing and have not yet graduated from high school, consider courses in math, computers, accounting, speech and business as a solid foundation for your future career.
While a medical billing certificate program will prepare you for a new career, you will likely receive quite a bit of additional training on the job. You will need to become familiar with laws specific to the state and the industry in which you are working, as well as the differences between the major insurance plans, Medicare, and Medicaid.
State and federal laws currently do not require certification to enter the field of medical billing; however, applicants who have taken the step to validate their expertise by becoming certified can have a competitive advantage over other job applicants. Several certifying organizations - such as the American Medical Billing Association (AMBA), the American Academy of Professional Coders (AAPC), and the Medical Association of Billers (MAB) - offer preparatory programs for their individual certification exams. Other organizations and institutions also offer preparation and certification; make sure the one you choose is widely recognized and reputable.
Even after passing the certifying exam, you should expect to participate in ongoing continuing education. This may be required to maintain employment or certification status, and is best practice to stay up to date with new regulations and guidelines.
Necessary Skills and Qualities
Successful medical billers have exceptional math and organizational skills. They also possess an aptitude for learning software programs, the ability to adapt to new challenges, and a keen attention to detail. These skills are needed to process and apply the many changes that commonly take place with healthcare regulations and billing software. Interruptions can occur frequently throughout the day, so a biller must be able to transition easily between tasks and assignments. Courtesy and confidence are essential communication traits, as medical billers commonly interact directly with patients and insurance representatives. As in all areas of healthcare, billers must be able to maintain strict confidentiality regarding patient services.
Opportunities for Advancement
Advancement opportunities within a healthcare organization include moving into management of personnel or patient accounts. Highly experienced medical billers with a strong work history are in enough demand that some start their own home businesses, giving them ultimate freedom over their schedules. To take advantage of every opportunity in this field, be sure to network with other experienced billers on medical billing forums. Becoming a member of professional associations, such as the AMBA, AAPC, or MAB, will allow you to keep in touch with people in your industry, and give you the inside track on new opportunities in the field.
If you would like to gain the necessary education to become a certified medical biller, we highly recommend that you check out our free School Finder Tool located HERE.
Salary and Job Outlook
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According to the US Bureau of Labor Statistics (BLS), the median annual wage for a billing clerk in any field is $34,410. As billing clerks working in the healthcare field, certified medical billers can expect to earn a similar amount, although the exact compensation will vary depending on the sector of the healthcare industry and the state.
Billers who work in private doctors' offices may earn slightly less than those who work in hospitals or medical laboratories. The BLS estimates that the median salary for a biller in a physician's office is $34,980, while in a hospital the median salary rises to $35,460. Because many employers prefer certified employees, salaries vary significantly between those with and without certification.
The Bureau of Labor Statistics expects employment of all billing clerks to increase by 11 percent from 2012 to 2022, which is about average growth. Demand for certified medical billers may even outpace that for billing clerks in other industries, due largely to the aging U.S. population and the fact that the elderly access the healthcare system more frequently than other age groups. If you have an eye for detail; are organized and adaptable; are able to communicate effectively, and have proficient computer skills, a career as a medical biller may be right for you.