medical coder and biller working

What does a Medical Coder and Biller do?

A medical coder has a distinctly different task to perform than that of a medical biller. A medical coder must document the services provided for the healthcare of a patient in a hospital outpatient facility. A medical biller concentrates on reimbursement and money related issues. They are more knowledgeable about commercial or private insurance requirements, what codes can be billed, claim submission rules, and how to assemble a clean claim. However, they work very closely to ensure all billing and codes are accurate.

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How to Become a Medical Coder and Biller

medical coder and biller working

A medical coder and a medical biller can both become certified in as little as 7 months with online courses or in college classes. Thoroughly research the credentials of the school offering the training. Look for a program that include courses in medical terminology, basic math, administrative skills, computer software training, and anatomy. All of this coursework will prepare you for you and help you successfully prepare for your certification.

Most individuals entering this career field complete the Certified Professional Coder (CPC) or Certified Coding Specialist (CCP) certifications which enables them to become more in demand for employment. According to those with specialized or additional credentials earned up to $65,643. Therefore, it may be advantageous to continue your education by obtaining additional certifications, a bachelor’s degree, or a master’s degree.

Job Description of Medical Coder and Biller

A medical coder uses complex codebooks to translate the information found to create payment claims that insurance companies or private parties must pay for services rendered. They may also have the duties of refiling appeals for denied claims or be an advocate for the patient and provider in areas of coverage and medical necessity.

A medical biller has the job of doing all aspects of the revenue cycle which includes payer requirements, claims procedure with government regulations, and private payer policies. They have the duties of resolving claim denials, submit appeals and manage collections, just to name a few. A medical biller would also be familiar with different insurance plans and understand rules that apply to the healthcare industry.

Medical billers know coding guidelines, such as HSPCS LEVEL II that pertain to non-physician services such as prosthetic devices or hospital transportation as well as other specialized codes. These jobs may be performed by the same person or two different individuals depending on the level of expertise and certification. You must be very detailed-oriented, efficient, analytical, technical, and have strong interpersonal skills in order to successfully work in this field. There is potential to work at home with this job, though you may need experience first.

Article Citations

Bureau of Labor Statistics, U.S. Department of Labor, Occupational Outlook Handbook, Medical Records and Health Information Technicians.

National Center for O*NET Development. 29-2071.00. O*NET OnLine.