What does a Medical Coder and Biller do?

medical coder and biller working

Disclaimer: The information on our website is provided for general information purposes only. We make no representations or warranties of any kind, express or implied, about the completeness, accuracy, reliability, suitability or availability with respect to the website or the information contained on our website for any purpose. Any reliance on such information is therefore strictly at your own risk and we are not liable for any damages or losses arising out of or resulting from your reliance on any information contained on our website.

A medical coder has a distinctly different task to perform than that of a medical biller. Additionally, they document the services provided for the healthcare of a patient in a hospital outpatient facility. Alternately, a medical biller concentrates on reimbursement and money related issues. In fact, 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. They work very closely to ensure all billing and codes are accurate. Watch a video to learn more.

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 AAPC.com 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.

Benefits of being a Medical Coder and Biller

Embarking on a career as a medical coder and biller offers a range of rewarding benefits, making it an appealing choice for many. This role is vital in the healthcare industry, as it bridges the gap between healthcare providers and insurance companies, ensuring that healthcare services are accurately billed and reimbursed. One of the significant advantages of this career is the opportunity for stability and growth in an ever-expanding healthcare sector.

With the increasing demand for healthcare services, the need for skilled medical coders and billers is on the rise, offering strong job security and potential for career advancement. Moreover, this profession offers the flexibility to work in various settings, including hospitals, clinics, and the possibility of remote work, which can provide a desirable work-life balance. For those who have a keen eye for detail and enjoy working in a structured environment, this role offers a satisfying professional experience. Additionally, it requires relatively short-term specialized training compared to other roles in the healthcare field, which means entering the workforce quicker and with less educational debt.

The role also provides a continuous learning environment, as medical coders and billers must stay updated with the latest coding systems and healthcare regulations, making it an intellectually stimulating career. Furthermore, it’s a career that contributes to the efficiency and effectiveness of healthcare delivery, providing a sense of pride and accomplishment in supporting patient care indirectly.

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.

Scroll to Top