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Importance of Medical Billing and Coding Careers
Why are medical coding and billing jobs so important? Because they are responsible for just about every task associated with getting the provider paid for their services.
The information they code, enter, and submit is what the insurance companies process to determine payment for the procedures performed on the patient.
The medical coding and billing process is extremely important to the financial health of the practice. If claims don’t get coded and submitted accurately and quickly, the practice doesn’t receive income.
Medical coding and billing specialists should be:
- Detailed oriented
- Good at data entry and math
- Understanding of the insurance process and medical terms
- Familiar with medical billing guidelines and compliance requirements
- Have a sense of urgency in getting claims paid
- Have good technology skills
What does a Medical Biller do?
Basically everything involved in getting a doctor or other health care professional paid for their services. This is both payment from the insurance carrier and the patient.
Medical billing specialists enter patient and patient visit information into the medical claim software, and submit these claims to insurance companies or government payers such as Medicare and Medicaid. These claims are usually sent electronically to the payer – but some are sent via paper using the standard CMS-1500 insurance form. It is very important that the information on the claims be accurate and complete.
Insurance billing specialists not only submit claims for medical procedures, but also medication, equipment and supplies, and consultations. Claims that are denied require follow up to either correct the claim and re-submit or provide the payer additional supporting information. A medical biller will many times respond to patient questions regarding their statement.
The biller periodically sends patient statements if there is a balance on the account after insurance payments have been posted. With the complexity of health insurance now, many times patients don’t understand what is covered, co pays, coinsurance, deductibles, and what their responsibilities are.
Medical billing is a tedious and time consuming process that needs people dedicated to the job to make sure the provider gets paid. Some providers try to save money by having someone else in the office do the billing in addition to their other responsibilities – and the results are typically as you would expect. Many unpaid and rejected claims, timely filing deadlines missed, patient balances uncollected – a lot of missed revenue.
The medical billing process is extremely important to the financial health of the practice. If claims don’t get submitted in a timely manner, the doctors don’t get paid.
What does a Medical Coder do?
A medical billing coder analyzes patient charts and assigns the appropriate code. These codes are derived from ICD-9 codes and corresponding CPT treatment codes and any related CPT modifiers.
Medical coding involves interpreting the patient chart of the medical services or procedures performed and assigning the correct diagnosis and treatment codes with the services. A medical coder should also understand the medical billing process and be familiar with specific coding requirements of insurance payers – both commercial and government.
Many medical coding specialists obtain some type of certification from a recognized professional organization. In general the more credentials you have, the greater your income potential.
Certification for medical billing and coding jobs are primarily offered by the following reputable organizations:
AMBA – Certified Medical Reimbursement Specialist – The American Medical Billing Association (AMBA) is probably one of the most recognized organizations offering medical billing certification through examination and education.
The Certified Medical Reimbursement Specialist (CMRS) is an exam based certification that demonstrates a knowledge in insurance reimbursement, medical terms, coding (ICD9, CPT4 and HCPCS), claim appeals, and compliance (HIPAA and OIG).
Healthcare Billing and Management Association – The Healthcare Billing and Management Association offers the Certified Healthcare Billing & Management Executive (CHBME) and Certified Medical Billing Associate (CMBA). However these tend to be designed more for executives, managers, and supervisors.
AAPC (American Academy of Professional Coders) is dedicated to advancing the medical coding profession. AAPC Certifications offered are:
- CPC – Certified Professional Coder
- CPC-H – Certified Coding Specialist – Hospital
- CPC-P – Certified Coding Specialist – Payer
- CIRCC – Certified Interventional Radiology Cardiovascular Coder
- CPC in 20 specialties
- CPMA – Certified Professional Medical Auditor
- CPCO – Certified Professional Compliance Officer
AAPC has a program called Project Xtern to help newly certified coders gain relevant and valuable experience to land their first medical billing and coding jobs. It also aids in working towards removal of the “apprentice” status.
Although Xterns are not paid, it does give you great exposure to potential employers and lets you gain on the job knowledge and experience. Placement in the program lasts approximately three months and there are over 200 locations participating.
For more info checkout the AAPC Xtern Program here.
AHIMA (American Health Information Management Association) is dedicated to the effective management of personal health information required to administer healthcare to the public. AHIMA Coding Certifications offered:
- CCA – Certified Coding Associate. This is an entry-level certification
- CCS – Certified Coding Specialist. More proficient coders
- CCS-P – Certified Coding Specialist – More proficient Physician Based coder
- CHDA – Certified Health Data Analyst
- RHIA – Registered Health Information Administrator
- RHIT – Registered Health Information Technician
- CHDA – Certified Health Data Analyst
- CHPS – Certified Healthcare Privacy and Security
Benefits of Certification for Medical Billing and Coding Jobs
Certification distinguishes you from others in the field and gives you an advantage when applying for medical coding and billing jobs over those who are not certified. It also shows your commitment to the profession and demonstrates to management that you are committed to self improvement.
Other benefits include improved income potential and opportunities for advancement, a demonstrated basic level of professional knowledge, and a commitment to ethics and the integrity of the profession.
Medical billing and coding certification is strictly voluntary in the United States as there are no laws that require those performing billing and coding to be certified.
Medical Billing Salary
See what type of salary you can expect and what effects pay. How much difference does experience make for a medical billing specialist salary? See how salaries compare to other medical office jobs.
Medical Coding Salaries
See what range in Medical Coding Salaries is. Learn how experience influences the Medical Coding Specialist Salary and compare to other Medical Office occupations.
Tips for Getting Billing and Coding Jobs
How to get your foot in the door for medical billing and coding jobs. What does it take to get notice by a potential employer and get hired for medical billing jobs?
Top Interview Questions for Medical Billing and Coding Jobs
Here’s some of the most common interview questions for medical billing and coding jobs that may help with your job interview preparation. We’ve also expanded on what the interviewer is likely looking for when asking these types of questions.
Medical coding and billing jobs are typically in a professional pleasant and comfortable office type of environment. Work schedule is typically a standard 40 hour daytime work week, Monday thru Friday. Overtime may be occasional. Most medical billers or coders don’t routinely interface with patients except to answer questions about their account statements – and this is almost always via phone.
They do have to routinely interface with physicians and other health care providers to answer questions necessary to resolve claim billing or coding issues. The medical insurance billing specialist may occasionally spend time on the phone with insurance companies in resolving rejected or unpaid claims.
Since medical billing and coding jobs do not interface much with the public, dress is typically casual and comfortable.
The Outlook for Medical Billing and Coding Jobs
The U. S. Department of Labor – Bureau of Labor Statistics projects an annual increase of over 14% in health care support occupations which includes medical billing and coding jobs. Although the Department of Labor does not specifically categorize the medical billing or coding jobs, they do project a greater than 20% increase in those performing healthcare support functions – which includes medical billing and coding jobs.
The Department of Labor also projected an increase of over 21% for professional and related occupations – or health care providers – that require medical coding and billing jobs. All these providers will need insurance billing specialists and medical coders. Another factor is the increased complexity and regulations that make the billing and coding functions even more important.
In summary the outlook for medical billing and coding jobs is great. And this is based on one of the most credible source available – the U.S. Department of Labor. Reference the Bureau of Labor Statistics Career Guide to Industries – Health Care.
Roll of Technology in Medical Billing and Coding Jobs
Practice management software and electronic medical records (EMR) are making the understanding of technology – computer and software – key to medical billing and coding jobs. In just about any setting – hospital, private practice, nursing home, clinic,lab – using a computer is now like using a pencil or pen was years ago.
The basic functions of most practice management and EMR software is fairly intuitive. However the capabilities of these programs can be overwhelming. These are basically tools for viewing, organizing, and managing large databases of patient and payment information. Good typing and data entry skills as well as good technology skills will make you much more productive in medical billing and coding jobs.
Having good technologies empowers you as an employee and makes you more valuable to your employer.
Here are some useful technology skills for medical billing and coding jobs:
- Word processing and spreadsheet – how to create and print documents in word processor. How to create basic spreadsheets of data using MS Excel or similar.
- Web navigation – the ability to search for information on the Internet and use a web browser.
- File management – upload and download document such as PDF or image files.
- Email management – compose, send, and receive email.
- Basic understanding of computer networks and servers – if the application resides on a PC, server, or online.
- Computer file management – most common file types and how to find and organize on a computer.
- How to use computer storage devices like hard disks, CDs, USB drives, zip disks, DVDs, etc.
- How to scan documents or images and upload in an application.
Once you learn to use a software program from one vendor, it’s typically much easier to get up to speed when upgrades are made or using another vendor’s application.
Using practice management software requires being able to enter or edit patient demographic or insurance info, enter diagnosis (ICD) and treatment (CPT) codes and associated charges, and post payments from insurance companies and patients.
Remember when considering medical billing and coding jobs that the benefits are important also. These can actually be considered another form of compensation. Health care, education and tuition, time off, 401(k) and retirement, work schedule flexibility, work from home options, etc.
If you are invited to an interview for medical coding and billing jobs, ask for a copy of the employers benefits summary – they usually have a brochure or its posted on their web site.
In our metro area one of the largest employers of medical billing and coding jobs is a university with a large medical research department. Although the university pay may be the same as other employers, they do have a generous benefit to enroll in the university with very generous tuition benefits.
This can be a great benefit it your goal is to achieve a bachelors, masters, or doctorate advanced degree. A good education is a benefit that can lead to significantly higher pay in the long run.
If you are trying to decide between two jobs, make sure you compare the benefits as well as the pay. One of the biggest benefits cost these days is health insurance so really scrutinize the plan costs and options when comparing jobs.
Work environment is another benefit to consider. How comfortable are you with your potential supervisor? Do the current employees seem stressed and unhappy? Is there a lot of turnover?
When going for an interview try to observe the mood of the other employees and trust your intuition. Women especially women can really detect when somethings not right in an office environment.
The current and future demand for medical services will create a good demand for medical billing and coding jobs for the foreseeable future. Medical billers and coders are a vital part of the medical records and reimbursement process. However with any career the more training and credentials you can obtain, the easier it is to find a good job and progress up the salary scale.
Medical Billing and Coding Jobs