By DeVry University
On a national level, the healthcare industry is growing1 and there is a wide variety of non-clinical jobs that help keep care facilities running. Among these non-clinical positions, medical billers and coders stand out as some of the most important. Medical billers and coders make sure patient medical records are correct, that the bills they receive for procedures and services are accurate and that they help support clinical workers by taking administrative tasks off their plate. Medical billers and coders help gather health information data that can be used to improve processes within a care facility, making them more effective during the treatment process.
To pursue a career in this field, you first need to know how to become a medical biller and coder. At DeVry, we've had years of experience helping students build their medical billing and coding abilities. In this article, you'll get a sense of what steps you'll need to take to become a medical biller and coder as we explore the following sections:
What are Medical Billers and Medical Coders?
Medical billers and coders are two different but closely related professions in the healthcare administration field. The medical coders primarily work to accurately catalog the care that has been provided to a patient, and medical billers work to properly bill them for that care once the patient has been released.
Here are brief descriptions to help you understand each career path a little bit more, and how they differ from one another:
What is a Medical Biller?
Medical billers are a vital part of the healthcare revenue management cycle. They are responsible for the submission of claims to health insurance companies, and as a part of this, they have to be knowledgeable about the different medical codes and the processes that insurance companies use in order to bill a patient. In the event that a bill is taking longer than usual to be paid, they are also responsible for following up with the recipient and remaining in contact with the insurance company until the bill is paid.
The job of a medical biller, beyond accurately charging insurance companies and patients for services rendered, is to help achieve optimal revenues for the care facility through the billing process. This can be done by keeping accurate records and diligently following up on unpaid bills to reduce the length of the healthcare revenue management cycle.
A partial list of job responsibilities for medical billers includes:
- Obtaining recommendations and pre-authorizations for treatments as needed.
- Examining eligibility and verifying benefits for treatments, hospitalization and procedures.
- Obtaining maximum reimbursement from insurance plans for services provided.
- Examining patient bills for correctness and completeness and gathering any missing data.
- Preparing, evaluating and sending insurance claims, including electronic and paper claim processing, using billing software.
- Examining each insurance payment for correctness and adherence to contract discounts.
What is a Medical Coder?
Medical coders are another part of the healthcare revenue management cycle. But instead of billing patients and insurance companies, they assign codes to treatments carried out by clinical professionals during a patient's care. CPT (current procedural terminology) codes correlate to different procedures, equipment or ailments, and are used to determine the cost of service.
In medical coding, the cost of service isn't the only thing the codes identify. By simplifying complex procedures into individual codes, it makes the data far easier to read. Once the data is put into this simplified format, facility administrators and managers can use this information to make important decisions that can go on to impact the allocation of funds within a care facility or be used to streamline the care process.
A partial list of job responsibilities for medical coders includes:
- Assigning codes to diagnoses and procedures using ICD (International Classification of Diseases) and CPT (Current Procedural Terminology) codes.
- Ensuring codes are accurate and sequenced correctly in accordance with government and insurance regulations.
- Following up with healthcare providers on any documentation that is insufficient or unclear.
- Receiving and reviewing patient charts and documents for accuracy.
- Researching cases where the coding is complex or unusual
Step-by-Step Guide to Becoming a Medical Biller or Medical Coder
As with any career path, there is no one way to become a medical biller and coder that works for everyone. However, there are some general steps you can take and prerequisites you need to be aware of as you work toward that goal.
Here are some of the steps that may help you on the path to becoming a medical biller or medical coder:
1. Enroll in an undergraduate certificate program
According to the Bureau of Labor Statistics, many medical billers and coders have some sort of postsecondary education, which may come in the form of an undergraduate certificate. Find a school that offers this kind of program, such as DeVry's Undergraduate Certificate in Medical Billing and Coding, and enroll to get your education started.
2. Complete your certificate program
After enrolling, you need to complete and pass the coursework in your undergraduate certificate. To help set you up for success, we recommend taking advantage of professor office hours, learning resources and any certification exam preparation that might be offered.
3. Pursue a medical billing and coding professional certification
Within the field of medical billing and coding, there are three major professional certifications:
- Certified Coding Specialist (CCS)
- Certified Coding Associate (CCA)
- Certified Professional Coder (CPC)
Each medical billing and coding certification tests your competency across slightly different areas. When considering which certification to pursue, choose the one that is most applicable to your specific career goals.
4. Look for potential job opportunities
Once you've earned your undergraduate certificate and your professional certification, it's time to start searching for jobs. Identify a few job titles that interest you and decide which employers in your area look like a good fit. Having clear goals on what time of environment you want to work in can help you streamline the application process.
5. Apply for positions regularly
It's not uncommon to apply and interview for a few positions before getting hired. Stay persistent and apply to as many jobs as you can until you find one that suits your goals and interests.
Discover a Career in Medical Billing and Coding
If a career in medical billing and coding sounds like it might be the right fit for you, then DeVry’s Undergraduate Certificate in Medical Billing and Coding program can be a great place to start. In this program, you'll have the opportunity to build your coding and billing skills while getting practice with real world scenarios in online lab courses. Classes start every 8 weeks.
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1Growth projected on a national level. Local growth will vary by location. https://www.bls.gov/ooh/healthcare/medical-records-and-health-information-technicians.htm