How to Become a Certified Medical Biller

Overview

Medical biller reviewing materials at her desk

Medical billers are vital to the business success of the healthcare industry. Their careful work submitting claims to insurance companies keeps business running smoothly for physicians, hospitals, third party billing companies and even the federal and state governments. A medical biller is able to contribute significantly to the healthcare industry without the long years of schooling required of many other jobs in the field.

Medical billers review hospital and patient records, calculate charges, submit claims and answer patient and insurance company questions regarding claims. A skillful medical biller helps healthcare facilities navigate Medicare, Medicaid, and the Health Insurance Portability and Accountability Act (HIPAA), a set of rules regarding the privacy, confidentiality and sharing of personal health information. Certified medical billers are those who pass the Certified Medical Reimbursement Specialist Exam, and are more highly sought after than those without certification. Medical billing offers an opportunity for an efficient, task-oriented individual to use his eye for detail in a critical role within the healthcare industry.

Work Environment

Certified medical billers work in hospitals, nursing homes, physicians’ offices, rehabilitation facilities, and third party billing services such as consulting companies or insurance companies. Each state government employs a large number of medical billers, as does the federal government as well. Most certified medical billers work full time, though job hours are flexible. Some develop their own businesses so that they can work independently from home.

Requirements

Education

Medical billing is a robust career field that is open to anyone with a high school diploma or equivalent GED certificate. Medical billing courses are often independent of standard degree programs at local colleges and therefore can be completed in the classroom or online. When selecting a medical billing course, choose one offered by an accredited organization that has been training medical billers for many years. If you are considering a career in medical 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.

Training

In preparation for a career in medical billing, basic medical terminology, diagnoses and coding must be memorized and understood. Medical billers must familiarize themselves with the laws and regulations for the state they work in as well as the differences among major insurance plans, Medicare and Medicaid.

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 may be required to take continuing education courses or be trained actively by a fellow biller in your first weeks.

Licensing and/or Certification

While state and federal laws don’t require certification to take a job in medical billing, most employers seek only certified applicants. A medical billing course from a respected school will ensure you are ready for the Certified Medical Reimbursement Specialist Exam. The American Medical Billing Association offers one of the most widely recognized programs.  Even after passing this exam, however, it is highly recommended that you stay up to date with new developments in the field and refresh your skills regularly. Because certification must be renewed periodically, ongoing education is a must.

Necessary Skills and Qualities

The healthcare industry is a complex environment, filled with legal and insurance requirements and a number of software tools for tracking patients and services rendered. So it’s no surprise that a successful medical biller is one with exceptional math, communication and organization skills, a keen understanding of computer software and a detail-oriented nature with the ability to adapt to new challenges. On the phone or at the computer most of the day in communication with insurance agencies, clients, and physicians, a medical biller is the hub of operations for the business side of the healthcare industry.

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 and become a member of associations like the American Medical Billing Association. Keeping in touch with people in your industry gives 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

As of 2010, according to the US Bureau of Labor and Statistics, the median annual wage for a billing clerk in any field was $32,170. As billing clerks working in the healthcare field, certified medical billers can expect to earn a similar amount, though the exact compensation will vary depending on the sector of the healthcare industry and the state. Certified medical billers who work in private offices or for insurance companies can earn higher salaries than those who work in hospitals, public health or Medicaid settings. Because most employers prefer certified employees, salaries vary significantly between those with and without certification.

Job Outlook

Employment of medical records and health information technicians is expected to increase by 21 percent from 2010 to 2020, and certified medical billers should expect similar job growth. Demand for certified medical billers in the healthcare industry continues to grow due to an aging U.S. population that requires more frequent medical tests, procedures and treatment, with a concomitant increase in claims.

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