How to Become a Medical Billing and Coding Specialist

Overview

In a fundamental way, the medical billing and coding specialist helps prevent our health care system from grinding to a bureaucratic halt! Through their work creating detailed billing records and efficiently coded invoices, these specialists ensure that the business side of health care does not obstruct the vital medical care that patients need. Without the contributions of the billing and coding specialists, neither doctors nor insurance companies could properly provide their services to patients.

These specialists bear much of the crucial responsibility for ensuring that appropriate payments and reimbursements are made. A medical billing and coding specialist enjoys two vital duties:

  • Keeping detailed records of healthcare services provided to the patient from the beginning to the end of a treatment process. The specialist relies on a formal coding system to guarantee accuracy and confidentiality
  • Using the coded information in order to invoice the patient or insurance company properly, without having to list each item in detail

To perform those two central duties, medical billing and coding specialists conduct a multistep process that includes the following necessary steps:

  1. Providing appropriate coding on the patient’s medical history, diagnosis, tests and treatment
  2. Making information clear and precise to ensure accuracy
  3. Using the coded medical records to create invoices that are sent to the patient and insurance company, as the case may be
  4. Accurately recording the patient’s and insurance company’s details into the system

The resulting medical billing records protect a patient's rights and allow the health care system to run smoothly.

Work Environment

Medical billing and coding specialists enjoy a variety of employment opportunities with different parties involved in medical billing. Many of these specialists find positions in medical facilities such as clinics or hospitals, or in private practices or other health-related facilities. Insurance companies and outsourcing companies hire many medical billing specialists as well. Some specialists choose to work on a contractual basis from home. In any of these environments, most billing and coding specialists work full time. Some find opportunity to work evenings and on weekends in medical facilities that remain open 24 hours a day.

Requirements

Education

While there is no formal educational requirement for this career, most employers only consider job applicants with a minimum of an associate’s degree from an accredited community college. Coursework in biology, chemistry, computer science and math strengthens 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 devised by business, government and the healthcare industry.

Licensing and/or Certification

Although not required, most employers seek candidates with a Certified Medical Reimbursement Specialist (CMRS) certification. The certificate process takes from 9 to 12 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 greatly raises the chances of landing a higher paying job.

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

Opportunities for Advancement
   
Most medical billing specialists begin their professional career in the front of the office, sharing reception and coding responsibilities. After gaining some experience, the specialists are promoted to positions of higher "back office" responsibility, where invoicing and key operations of the office or agency take place. With additional education and experience, a billing and coding 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

According to the Bureau of Labor Statistics, the median salary for all billers (including medical billing and coding specialists) was $33,820 per year as of May 2013. The lowest 10% earned less than $23,750 and the highest 10% earned over $47,930. In doctors' offices and hospitals, these specialists earn average yearly salaries of $34,500 and $34,890, respectively.

Job Outlook

Billing and coding specialists with certification enjoy the greatest job outlook. Overall, the BLS projects a better than average job growth of 18% 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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