What Does A Medical Biller & Coder Do?

Healthcare jobs are increasing at a faster rate than average. Medical billers and coders are needed to handle insurance and patient claims. MTI College offers a Medical Billing and Coding Professional Diploma Program that can prepare you to enter this in-demand field. You could be working alongside doctors and nurses in a hospital, doctor’s office, clinic, nursing home or other medical facility using your skills to provide much-needed assistance.

Because more people have access to health insurance these days, claims on behalf of patients are going to increase. If you have a medical billing job, you will be the one to submit the bills for insurance reimbursement.

Does this sound like a job you would enjoy? Find out what a medical biller and coder does on a day-to-day basis and learn whether it is a good career choice for you.

What is medical billing and coding?

Medical billing and medical coding are two interrelated jobs that help facilitate payment between health care providers, insurance companies, and patients. Through the Medical Billing and Coding Professional Diploma Program offered by MTI College, you will learn both medical billing and medical coding.

Let’s look at each specific job, and how they help medical offices run smoothly.

There is usually some overlap between medical billing and coding, but this is a succinct way to describe each job.

• Medical coders transcribe a patient visit and physician’s treatment into a series of universally agreed-upon codes. These codes are used by health care providers, hospitals, insurance companies to create a record of a patient’s visit and submit an insurance claim. Each code has guidelines on how they can be used, so accuracy is essential.
• Medical billers take the codes prepared by the medical coder and submit claims to the insurance company. They then follow up with both the insurance company and the patients to make sure the medical office is compensated properly, the patient is billed correctly, and timely payments are made.

When you train at MTI College, you train for both positions. If you work in a small office, you may also perform the duties of a medical coder, a person who applies industry-standard codes that relate to specific medical diagnoses, treatments and procedures to patient health records. The medical biller then takes the coded information and submits the bill. However, if your job is for a larger organization, you may just do medical billing or medical coding.

What does a medical coder do?

The medical coder transcribes what happens during a patient visit so that insurance companies and health organizations can understand it. Medical coding takes information, such as a physician’s diagnosis, patient symptoms, or a doctor’s prescription, and turns that into numerical or alphanumerical codes.

These codes describe each injury, diagnosis, prescription, and medical procedure. This is important for both the patient’s medical records, the doctor’s office or hospital, and the insurance claims processor. The medical coder is a translator for each of these entities, tabulating what happens during a patient appointment.

The standard that is almost universally used are the ICD (International Classification of Diseases). In the United States, HCPCS (Healthcare Common Procedure Coding System) is used to submit claims to Medicare and other forms of health insurance. HCPCS consists of two levels, Level I and Level II. HCPCS Level I is also known as CPT (Current Procedural Terminology).

Whenever you go to see your physician or health care provider, each part of your visit is notated by the doctor or medical assistant. The medical coder uses the coding standards described above to put together a record of your doctor’s visit. Each code matches up to a sickness, a service provided by the medical office, a prescription, or test. This record is used by the medical biller to submit a claim to the insurance company.

It is very important for the medical coder to transcribe the record of the visit accurately. Because each code has it’s own guidelines, and rules for the order in which they are placed. If the coding is done inaccurately or incorrectly, it can affect the status of the insurance claim.

Once the codes transcribing the patient visit are input into the computer, that information is passed along to the medical biller.

Here is a summary of tasks a medical coder is responsible for:

• Review and analyze clinical statements & patient records
• Translate diagnosis and medical information into codes using CPT, ICD-10-CM and HCPS Level II classification systems
• Interact with physicians and assistants to ensure codes are accurate and ready to be converted into a medical billing claim.
• Maintaining patient confidentiality and information security

What does a medical biller do?

A medical biller takes the coded transcript of the patient visit, and inputs that information into special software. This information is submitted to the patient’s insurance company as a claim.

After the insurance company pays their portion, the remaining amount is billed to the patient. Any co-pays and deductibles are figured into this revised amount. As with medical coding, accuracy is very important in medical billing.

The medical coder and medical biller work in tandem to make sure that the health services are being tabulated accurately, that information is passed to the insurance company, and the revised invoice is sent to the patient. Both jobs are very important to ensure that the health care facility is reimbursed correctly.

The medical biller plays a vital role in the relationship among medical providers, patients and insurance companies. Although the medical biller is not responsible for patient care, he or she should have a good understanding of medical terminology to be able to discuss medical bills with both insurance carriers and patients. These are a few duties of a medical biller:

• Audit and submit claims to insurance companies for patient procedures and treatments.
• Obtain insurance referrals and pre-authorizations for patient procedures.
• Verify insurance eligibility and benefits.
• Understand insurance guidelines, including those for HMO/PPO, Medicare and Medicaid.
• Review patient bills for accuracy and fill in any missing information.
• Check payments for accuracy.
• Research and appeal denied claims.
• Talk with insurance companies about payment discrepancies.
• Set up payment plans for patients.
• Collect delinquent accounts.
• Answer phone inquiries from patients and insurance companies.
• Use medical billing software to perform job duties.
• Update software with rate changes.
• Know Fair Debt Collection Practices.

As a medical biller, you may not perform each of these duties every day, but they are all considered responsibilities of the job.

Job outlook for medical billing and coding

According to the Bureau of Labor Statistics, the employment rate for medical records and health information technicians (medical billers and coders) will grow 11 percent from 2018 to 2028, much faster than the average rate for other occupations.

What is the average salary for a medical biller and coder?

The Bureau of Labor Statistics shows that health information technicians (billers and coders) earned a median salary of $40,350 in 2018. The BLS also showed the top 10% of medical billers and coders earned an average of $66,260 in 2018.

A 2017 survey by the American Academy of Professional Coders (AAPC) of almost 13,000 health care professionals shows that medical billers and coders earned a median salary of $52,441 in 2017. Coding and billing managers earned even higher pay rates, with an average of $64,623.

Another AAPC survey in 2018 showed medical coders in Pacific states like California earned an average salary of $59,134.

Interestingly, the AAPC survey showed that the higher the degree achieved, the higher the average salary was for medical billers and coders.

What are common career paths for a medical biller and coder?

Working as a medical biller and coder means you will work with medical offices and patients. You will need to be able to read and transcribe patient charts, turn that into the correct codes, and submit the billing as an insurance claim.

Here are some of the facilities where medical billers and coders work.

• Hospitals
• Physician’s offices
• Nursing homes
• Home health care
• Outpatient facilities

In larger facilities, like a hospital, your career path may take you into medical coding management.

What personal skills are helpful for a medical biller and coder?

A medical biller and coder is very important to the financial cycle of a health care provider, and you need to always strive for accuracy.

These are some other skills you should possess if you want to be a medical biller:

• Attention to detail. You’ll always need to check bills for accuracy and identify discrepancies.
• Excellent communication ability. Much of your job will involve phone conversations with patients and insurance companies.
• Good customer service. Remember that the bottom line is a person’s healthcare management, and it can be an emotional topic for some people. You need to speak diplomatically, compassionately and accurately to answer questions.
• Computer knowledge. Since you will be using medical billing software, you should know how to use a computer and the Internet.
• Accounting and bookkeeping. An understanding of the basics can be very helpful since you will be sending out billing statements and will need to reconcile them as payments come in.
• Medical terminology. Your MTI training will cover this, but you need to keep up to date to be able to converse with patients, providers and insurance companies.
• Problem solving. Sometimes there will be discrepancies or inconsistencies, and knowing how to go about solving the problem is necessary.
• Being comfortable with teamwork. Since you will interact with other medical staff members, you should enjoy working as part of a team.

What certifications do you need to pass to become a medical biller and coder?

Most health care providers require applicants to be certified as a medical biller. The certification that is most recognized is the CMRS exam (Certified Medical Reimbursement Specialist). This certification is overseen by the CBAMBA (Certifying Board of the American Medical Billing Association). There are 800 questions on this exam, and you must pass with 85% to become certified.

To become certified as a medical coder, you can take the CCA (Certified Coding Associate) exam. The prerequisite is to take a AHIMA (American Health Information Management Association) approved program.

Get started on your path to become a medical biller and coder