Medical Billing Career Options

Medical Billing Certification Options

While certification in medical billing is not a requirement to work in the field, some employers prefer certification.

Larger employers such as hospitals place more emphasis on certification. The advantage is it makes you more appealing to potential employers, justifies higher pay, and can lead to better opportunities for advancement.

There are two professional organizations which offer certification in medical billing:

AMBA – American Medical Billing Association offers the Certified Medical Reimbursement Specialist (CMRS).

AAPC – American Association of Professional Coders offers the Certified Professional Biller (CPB).

Certified Medical Reimbursement Specialist (CMRS) Exam

CMRS exam. This is a comprehensive 800 question exam that covers all aspects of the medical billing process. Taking the exam requires membership in AMBA which costs $99 a year. The exam is given online and requires an 85% grade to pass. The CMRS exam has covers several areas:

  • Medical Terminology
  • Anatomy and Physiology
  • Information Technology
  • ICD-10-CM Coding
  • CPT Coding
  • EDI Transactions & Clearinghouses
  • CMS-1500 Form
  • Insurance Types and Carriers
  • Acronyms and Healthcare Terms
  • HIPAA & Compliance
  • Managed Care
  • Fraud & Abuse

The exam is open book and the examinee is allowed 45 days to complete the exam. If a passing grade of 85% is not obtained, two free retakes are allowed within 60 days after a 30 day waiting period.

Maintaining certification requires completion of 15 credits of continuing education every year. Qualified continuing education can be taken through several professional organizations.

American Academy of Professional Coders (AAPC) Certification

AAPC offers the Certified Professional Biller (CPB) upon successfully passing the CPB exam.

The CPB exam is 200 questions that must be completed in one sitting. A passing grade is 65%.

Maintaining the AAPC CPC certification requires 36 continuing education credits every two years and membership in AAPC which is $160 a year ($90 for students).

If choosing between the two, would recommend AAPC certification. Just visit their websites to draw your own conclusions but AAPC seems to have a more extensive community and recognition in the healthcare community.

AAPC is an excellent organization which offers extensive coding resources and specialty certifications.

Where Medical Billing Jobs Are

  • Healthcare Providers
  • Hospitals
  • Insurance Companies
  • Billing Services
  • Government Agencies
  • Consulting
  • Entrepreneur
  • Education

Getting a Job With No Experience

Although there are a lot jobs in billing and coding, one of the biggest challenges in getting that first job is that most employers want some experience. So how do you get any experience if nobody will hire you?

There are many administrative jobs in healthcare. Clerk and receptionist jobs get you exposed to the medical office environment and around people in the field.

Volunteer to work as an intern or job shadowing assignment. This is sometimes part of a vocational program.

Join a local chapter of a professional organizations. AAPC has a local chapter in just every city across the United States.

Working From Home

Situations where billers and coders are allowed to work from home:

  • If the employer allows it.
  • Contracted as a Business Associate.
  • Business that provides services to a provider such as a billing service.

Anyone working for a health care provider may remotely access health information systems and use mobile devices to access electronic protected health information (ePHI) in a cloud.

HOWEVER the systems and devices must have appropriate physical, administrative, and technical safeguards are in place to protect the confidentiality, integrity, and availability of ePHI.

Starting a Medical Billing Business From Home

Those who start a Billing Services business typically have some experience.

Any program that promises you can immediately work from home by taking an online course is delusional.

The value of any training – whether it’s online or not –  is what it teaches you. Consider what the instructor or organization delivering the course has accomplished. If they are trying to sell you a course or program starting a business from home, have they done so successfully?

We don’t emphasize the Starting a Medical Billing Business from Home route because it’s not for everyone and we don’t want to mislead people without knowing all that’s involved. Although we started a vibrant billing business from home, most of what we learned was through experience and self learned from a variety of sources.

Remember that medical billing and coding are extremely important to the financial health of a providers office. Its a very complex process. They’re not going to hand these responsibilities off to someone who has never gotten a claim paid before.

Stay away from any program that provides you a software, a few generic instructional books, and a listing of physicians that supposedly need a billing and coding services.

There’s much more info on starting a medical billing business here.

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