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Key Takeaways
- Medical billing and coding requires a high level of technical proficiency, but detail-oriented individuals who can learn quickly often thrive in this profession.
- In addition to a thorough knowledge of coding, medical terminology and the U.S. healthcare industry, medical billers and coders need soft skills such as communication and customer service.
- A college degree is not required to become a medical biller or coder, but it can boost your employability.
- Aspiring medical billers and coders can prepare for careers in the field through certificate, associate degree and bachelor’s degree programs, or through certification prep courses.
Not all medical professions involve direct patient care. Plenty of healthcare jobs still allow you to make an impact in the field while working behind the scenes.
Medical billing and coding is one of these professions. It involves analyzing healthcare data and translating it into a standardized code to bill insurance companies and patients. This profession is detail-oriented and technical, but is medical billing and coding hard?
Medical billing and coding might be complex, but it’s certainly not impossible to master. Let’s take a look at what medical billers and coders do.
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What Do Medical Billers and Coders Do?
What is medical billing and coding, and what do these professionals do on the job? Let’s dive in.
Role and Responsibilities
Medical billers and coders are the backbone of the healthcare reimbursem*nt cycle. Sometimes, one professional takes on both billing and coding duties. Other times, these duties are handled by separate people.
Medical billers and coders are responsible for ensuring healthcare providers receive payment for their services. When a patient sees a doctor at a clinic, hospital or physician’s office, medical staff records data about the visit. That data, also known as clinical documentation, includes information like diagnoses, procedures and prescriptions.
Coding treatments and diagnoses with specific code sets enable us to track data, implement protocol adjustments and gain insights into disease processes. This data allows us to analyze statistics at local, state, national and global levels.
—Alicia Scott, education director, CCO
In addition to these tasks, medical coders play an important role in helping healthcare organizations manage information on a larger scale. “Coding treatments and diagnoses with specific code sets enable us to track data, implement protocol adjustments and gain insights into disease processes,” says medical coding educator Alicia Scott. “This data allows us to analyze statistics at local, state, national and global levels.”
Day-to-Day Tasks
Medical coders translate clinical documentation into standardized codes. They use specialized coding software and coding classification systems, like Current Procedural Terminology (CPT®); International Classification of Diseases (ICD-10-CM); International Classification of Diseases, 10th Revision, Procedure Coding System (ICD-10-PCS); and Healthcare Common Procedure Coding System (HCPCS) Level II.
Medical billers receive these codes and use them to create a bill, or claim. They then send these claims to the patient’s health insurance company or a federal agency, like Medicare, for reimbursem*nt. If insurance doesn’t cover all of the costs, billers monitor outstanding medical bills to ensure payment from the responsible parties.
Succeeding as a medical biller and coder requires a strong knowledge of coding systems and the ability to learn quickly. You’ll need sharp memorization and communication chops.
While medical billers and coders do not provide direct patient care, answering patient questions regarding claims is a part of the role. Medical billers also spend a lot of time in direct communication with insurance representatives, while coders liaise with providers.
Work Environment
Medical billers and coders commonly work in hospitals, physician’s offices, management positions, accounting services and nursing facilities. Other industries need medical coding and billing professionals, too, including insurance carriers, scientific research centers and technical consulting services.
According to the 2023 Salary Survey from leading medical records and health information technology organization AAPC, 55% of medical records specialists work remotely.
Salary and Job Growth
The median medical billing and coding salary is $47,180 per year as of 2022, according to the U.S. Bureau of Labor Statistics. Employment in the medical records specialist field, which includes medical billers and coders, is projected to grow by 8% between 2022 and 2032—more than double the average projected growth rate for all other occupations. Over that same period, about 16,500 medical records specialist jobs are expected to open each year.
Top Skills for Medical Billing and Coding
What skills are required for a successful medical billing and coding career? Alongside a thorough knowledge of medical and coding terms, excellent medical billers and coders should possess the following soft skills.
Strong Communication
Medical billers and coders interact with other professionals daily, so they must be comfortable with written and verbal correspondence and practice clear, effective communication.
Of course, communication gaps do occur. It is just as important for medical billers and coders to have conflict resolution and problem-solving skills.
Attention to Detail
Medical codes are highly specific, so attention to detail is key. Entering a wrong character into the coding or billing software could throw a wrench in your work. You’ll also need to scan bills for inaccuracies and discrepancies, which requires a keen eye for detail.
Ability To Learn New Software
Medical coders use specialized software to generate medical codes from clinical documentation. Billers use software programs to automate billing tasks, such as verifying patients’ insurance plans, processing claims and submitting payments.
While you’re not expected to master every type of software, you should know how to familiarize yourself with new software as it’s introduced.
Customer Service
Medical billers and coders must regularly meet patient inquiries and requests. This is where great customer service skills come in. You might be asked to explain industry jargon or help a patient understand their medical bill, for example. No matter what patients ask, medical billers and coders should always respond with patience, respect and professionalism.
Medical Billing and Coding Courses
Professional certification is essential to success in medical billing and coding, but a higher education degree is not necessary to enter the field. However, a degree in medical billing and coding, healthcare management or another related field could increase job prospects.
Here are a few courses you can expect to take while completing a billing and coding degree or certification prep program.
Pathopharmacology
Pathopharmacology is the study of human diseases and how they’re treated. In this course, you’ll learn how clinicians wield drug therapy strategies against various diseases. You’ll also study disease etiology (the causation of diseases), diagnostic measures, dosages, drug administration and how to spot symptoms.
Introduction to Health Services and Information Systems
This course provides an overview of the history and organization of the U.S. healthcare system. You’ll learn about the system’s current challenges and explore the relationships among healthcare network components, including patients, providers and other healthcare professionals.
Basic Medical Terminology
In this course, you’ll learn the fundamentals of medical terminology. Students review the terminology used to describe medical procedures, medications and the human body and its conditions.
Health Insurance and Reimbursem*nt
In this class, you’ll explore common reimbursem*nt and payment methodologies used in U.S. healthcare systems.
Is Medical Billing and Coding Hard?
Medical coding and billing is technical, requires great attention to detail and demands sharp communication and problem-solving skills. This may prove challenging for some, while others might find it fits right into their natural working style.
Education and Training
You don’t need a degree to become a medical biller and coder, but it’s recommended to bolster your resume and job opportunities. Completing an associate degree takes two years, while a bachelor’s degree typically takes four. Billers and coders can also pursue shorter academic certificates from colleges, which typically take six to 18 months to complete, or courses from independent educational companies, which usually run four to nine months.
Medical records specialists may take various medical billing and coding certification online courses to enhance their training. Certifications demonstrate your expertise in medical billing and coding, and employers typically expect new hires to hold certification or earn a credential shortly after starting work. Requirements for medical billing and coding certification vary, so check with your prospective provider for details.
Common medical billing and coding certifications include:
- Certified Professional Coder (CPC®)
- Certified Coding Specialist (CCS)®
- Certified Coding Associate (CCA)®
- Certified Professional Biller (CPB)®
- Certified Medical Reimbursem*nt Specialist (CMRS)
To pass the CPC exam, you’ll need to understand anatomy, the business of medicine, and how to code a variety of patient services. The CPC is recommended for medical coding careers in physician’s offices.
How long it takes to obtain this expertise varies, but it could take several months—or years—of job experience. It’s recommended to have a minimum of one year of coding experience to become CCS certified, or at least six months of coding experience to become CCA certified. To maintain certification, you’ll typically need to complete continuing education and pay membership fees to the sponsoring organization.
Beyond medical billing and coding certification training and exams, this profession involves constantly learning on the job. This profession is a good fit for those who enjoy memorization and career-long learning.
Ultimately, becoming a medical biller and coder requires a certain level of rigor and tenacity. But if you’re up for the challenge, it can be a great career fit.
Frequently Asked Questions (FAQs) About Medical Billing and Coding
How do you start a career in medical coding?
If you have experience in a related field like healthcare information management, you can start by searching for billing and coding jobs in your area. Higher education isn’t required for medical billing and coding, so it’s possible to find the right job match without a degree.
If you don’t have previous experience in a related field, you may start with a medical billing and coding training course. This prepares you to take certification exams to advance your career.
How many months is a medical coding course?
How long it takes to complete a medical coding course depends on the program and the student’s enrollment pace. San Francisco State University’s online course can take up to nine months to complete, for example, while Columbus State Community College’s primarily online certificate takes about a year.
However, you can find courses that fast-track the process, especially if you have professional experience in the healthcare industry. Some online courses take as little as four months to complete.
What is the cost of medical coding training?
The cost of medical coding training depends on the program. Some programs cost a couple thousand, while others cost more than $10,000. You can find online programs, like the medical billing and coding course at the U.S. Career Institute®, for under $2,000.
Some programs offered by public universities are less expensive for in-state students. Santa Barbara City College, for example, charges a $1,748 in-state tuition fee for its medical billing and coding program. Out-of-state tuition costs $12,578.
How much do medical coding certifications cost?
The cost of a medical coding certification depends on which credential you pursue. The CPC certification exam costs $475 for students and $499 for all other applicants, whereas the CCS exam ranges from $299 to $399. The CCA exam fee ranges from $199 to $299.
Certification candidates should also budget for additional related expenses, such as codebooks and professional membership fees—for example, CPC test takers must hold AAPC membership, which costs $145 to $210.
