How to Become a Certified Medical Biller

By: Karen Ewing, CPC, COBGC

Last Updated: Dec 25, 2018

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.

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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.

Workplace Details

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.

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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 $36,150. 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 $36,890, while in a hospital the median salary rises to $37,380. 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 6 percent from 2014 to 2024, 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.

Medical billing is a robust career field that is technically open to those with a high school diploma or equivalent GED certificate. However, most employers have begun looking only at candidates who have obtained more education either in the form of a certificate program or an associate degree program.

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.

Medical billing certificate programs 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.

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Associate degree programs typically require two years of study. When it comes to degrees in medical billing, the programs are not regulated very well and many students fall prey to bad programs, only to find later that they’re ill-prepared to find work. Your best bet for an associate degree is one in health information management; this is two years very well spent, preparing you for medical billing as well as a broader possible spectrum of roles in healthcare. Your expertise would be in high demand.

When selecting programs, whether it’s a certificate or associate degree program, 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.

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), the American Health Information Management Association (AHIMA), and the Medical Association of Billers (MAB) - offer preparatory programs for their individual certification exams. Other organizations also offer preparation and certification; make sure the one you choose is widely recognized and reputable.

While a medical billing program will prepare you for a new career, you will likely receive quite a bit of additional training on the job. You’ll 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.

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.

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.

Many certified medical billers learn their skills on the job. If you want to go this route, your biggest challenge will be landing a medical office job without experience.

One strategy for landing that first job is to look for a registered apprenticeship. Apprentices get paid to learn while working, and their salary increases with experience. After about a year, you’ll earn a certificate of completion that is recognized by employers across the country.

If you are still in high school, there are many things you can do now to strengthen your resume. Take as many courses as you can in business, office administration, human anatomy, and computer science. Also, try to gain some work experience while you’re still a student. Many high schools and districts have job placement programs.

Finally, in order to be eligible for the more recognized medical billing certifications, you’ll need a high school diploma or equivalent. If you’ve been out of school for a while and haven’t formally graduated, contact your state’s department of education to explore your options.

Ramping up your coding skills can help to boost your billing career in several ways.

First, billers who graduate from a certificate program in coding are quite attractive to employers. (In fact, it’s probably more important than being certified in billing.) Earning your coding certificate is one of the best ways to prepare for a coding certification exam - especially if you are new in the field. Improving your coding skills can also be helpful if you plan to pursue medical billing certification.

Second, coding is an extremely important and complex part of your job as a certified medical biller. Investing in some education could speed up your learning curve by months or years, thereby increasing your value to your employer.

Many organizations offer certificate programs in coding, including 2-year colleges, career and technical institutes, and the professional societies AAPC and the American Health Information Management Association (AHIMA). Many programs offer online learning options, which can be a great option for working professionals.

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Before enrolling, make sure the program you’ve chosen is of good quality. AHIMA maintains a list of approved coding certificate programs on its website. Be especially wary of expensive for-profit schools, because they don’t necessarily deliver a better education. If you’re not sure whether a program is reputable, ask a working coder or someone who hires coders.

Certificate programs in coding cover:

While an associate degree isn’t required for medical billing certification, it can open other doors in your career. Many employers - particularly the better-paying ones - give hiring priority to candidates with degrees. You’ll also earn college credits that can count toward a bachelor’s degree if you wish to pursue one later.

So what’s the best major for a certified medical biller? Interestingly, an AAS in medical billing and coding can be a risk, because no academic accreditor provides educational oversight in this field. If you do go this route, verify that the program has a good reputation with employers and working coders.

Another option is an AAS in health information management, or HIM. This is a comprehensive degree that covers not only medical billing and coding but also subjects like health records management, data analysis, and informatics.

The Commission on Accreditation for Health Informatics and Information Management Education (CAHIIM) accredits HIM programs. You must graduate from an accredited program to be eligible for HIM certification.

When studying medical billing at the associate level, you’ll take subjects like:

A final note: if you enjoy your HIM program, consider earning a bachelor’s or even a master’s degree in the field. They aren’t necessary to work as a certified medical biller, but they can be useful if you want to move into management or teaching.

The term “certified medical biller” can refer to someone with national credentials in coding, billing, or HIM.

The most recognized certifications for coders include:

• Certified Professional Coder (CPC) – AAPC. Candidates must pass an exam and meet minimum experience requirements
• Certified Coding Associate (CCA) and Certified Coding Specialist (CCS) – AHIMA offers two levels of credentialing. The more advanced CCS has education and experience requirements and is designed for coders with several years of professional experience.
• This is by no means an exhaustive list. Coders can certify their expertise in specific payment settings (outpatient), skills (rate adjustment), and clinical areas (neurology). There are many organizations offering coding certification, and some are more recognized and reputable than others. Talk to your employer, academic advisor, or mentor about which credentials make sense for you.

Several organizations also offer certification in medical billing. Candidates must generally hold a high school diploma and pass an exam. Again, some of these credentials are better recognized than others, so talk to a mentor in the field about which ones will enhance your resume.

• Certified Professional Biller (CPB) – AAPC
• Certified Medical Reimbursement Specialist (CMRS) – American Medical Billing Association
• Certified Medical Billing Specialist (CMBS) – Medical Association of Billers

AHIMA offers two levels of certification in HIM. Candidates must earn a degree from an accredited college and pass an exam.

• Registered Health Information Technician (RHIT) – entry-level, requires an associate degree
• Registered Health Information Administrator (RHIA) – advanced, requires a bachelor’s degree or higher