How to Become a Medical Billing and Coding Specialist

Overview

By Karen Ewing, CPC, COBGC (AAPC), MT (ASCP)

The medical billing and coding specialist is at the center of the health care revenue cycle. By creating precise service and billing records, these specialists allow health care providers to concentrate on caring for patients; permit insurance companies and other payors to efficiently process claims; and offer reassurance to patients that their statements are accurate. To accomplish these objectives, the medical billing and coding specialist:

  1. Keeps detailed records of all healthcare services provided to the patient
  2. Maintains current files of the patient’s demographic, insurance, and account information
  3. Translates all of these records into codes that reflect the patient’s medical history, diagnoses, tests, and treatments
  4. Uses the coded data to create invoices or claims that accurately and confidentially report services provided and the patient’s conditions.

A proficient medical billing and coding specialist performs these duties well, and contributes to the smooth functioning of the business of health care.

Work Environment

Medical billing and coding specialists enjoy an array of career opportunities with a variety of employers. Many find positions in medical facilities, such as clinics, hospitals, private practices, or other health-related facilities. Insurance and outsourcing companies also hire medical billing and coding specialists, as do government services such as Medicare and Medicaid. In most instances, employment is full-time, in an office environment, during normal business hours; however, 24-hour medical facilities may offer or have requirements for evening and weekend hours. Opportunities to work from home are increasing in number.

Requirements

Education

While there are no formal educational requirements for this career, many employers will only consider job applicants with a minimum of an associate’s degree, such as from an accredited community or technical college. Coursework in biology, chemistry, computer science and math will strengthen a resume.

Training

Most employers provide on-the-job training, but the employee must prove his or her mastery of nationally recognized billing and coding standards developed by business, government and the health care industry.

Licensing and/or Certification

Although not required, most employers seek candidates with a Certified Medical Reimbursement Specialist (CMRS) certification. The certificate process takes nine to twelve months to complete and covers basic knowledge in physiology, anatomy and the sciences. Other important components of the certification include:

  • Medical terminology
  • Computer database management
  • Billing and coding procedures
  • Insurance procedures

Although strictly voluntary, becoming certified increases the likelihood of securing a higher paying position.

Necessary Skills and Qualities

The American Health Information Management Association (AHIMA) identified skills required for medical billing and coding specialists. These include:

  • Ability to work independently
  • Strong knowledge of the subject
  • Good critical thinking and communication skills

Specialists must have high ethical standards due to the confidential nature of patient information. Empathy is also required, as the specialist must be able to explain charges and invoices to patients and their families, often under stressful conditions.

Opportunities for Advancement

Most medical billing specialists begin their professional career at the front desk, sharing reception and coding responsibilities. After gaining some experience, the specialists are promoted to positions of higher responsibility, where invoicing and key operations of the office or agency take place. With additional education and experience, a specialist can attain further advancement to the role of office manager, billing administrator or supervisor.

If you would like to gain the necessary education to become a medical billing and coding specialist, we highly recommend that you check out our free School Finder Tool located HERE.

Salary and Job Outlook

Interactive Map of Income and Job Growth Projections

Hover over any state to explore local income and job growth data.

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According to the Bureau of Labor Statistics, the median salary for all billers (including medical billing and coding specialists) is $34,410 per year. The lowest 10% earn less than $24,090 and the highest 10% earn over $48,860. In doctors' offices and hospitals, these specialists earn average yearly salaries of $34,500 and $34,890, respectively.

Billing and coding specialists with certification enjoy the greatest job outlook. Overall, the BLS projects an average job growth of 11% for these professionals between 2012 and 2022. Recently, however, some companies have begun outsourcing medical transcription and records processes. Whether this becomes a growing trend remains to be seen in the coming years. As more people are expected to seek medical care in coming years, there should be a growing need for billing and coding specialists.

Related Careers

Also, check out our Health Careers page for more career guides.

Further Reading

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