Medical Billing & Coding Job Duties, Requirements, & Salary
Posted on 11.14.2023
If you’ve ever considered a job in healthcare but don’t want to work directly with patients, medical billing and coding may be a good fit! But, what do medical coders and billers do? And why are they in demand? The American Medical Association (AMA) reported that as of spring of 2023, the U.S. is experiencing a 30% shortage of medical billers and coders (Source, accessed November 14, 2023: https://www.ama-assn.org/about/leadership/addressing-another-health-care-shortage-medical-coders). The shortage isn’t due to turnover, either. Medical billing and coding professionals are aging out–as in retiring–and there aren’t enough qualified people to replace them. This is causing an impressive job outlook of 8% according to the Bureau of Labor and Statistics’ latest data (Source, accessed: November 14, 2023: https://www.bls.gov/ooh/Healthcare/Medical-records-and-health-information-technicians.htm).
While most healthcare-related jobs are in demand, there aren’t many that can potentially be done remotely, with minimal education, and with little-to-no patient interaction. So, whether you’re looking for a career change or trying to find a job that fits your needs, keep reading. We’ve got the answers to your questions about medical coding and billing jobs, duties, and of course, salary information.
What do medical coders do and what do medical billing professionals do?
Medical billing and medical coding are different and their duties rarely overlap unless you are working for a small, private practice.
In short, medical coding professionals take the provider’s notes, including diagnoses, medications, treatments, and services provided, and translates them into codes. The codes are a mix of letters and numbers that stand for different types of medical services, diagnoses and so on. They’re used for billing and insurance reasons. Think of it as a simplified language for a patient’s medical history, because every doctor and insurance company in the U.S uses the same codes.
Medical billing professionals, on the other hand, are responsible for submitting claims and following up with health insurance companies to collect payment. They make sure patients are billed accurately and providers are paid for their services.
Now that you know the difference, let’s get into the details of becoming a medical billing or coding professional: what education you need, what a typical day looks like, and your potential earnings.
Medical billing professional job overview
As stated above, medical billers create and send claims to insurance companies and patients in order to collect payment for services received by a medical provider. That’s the job in a nutshell, but what exactly does a medical biller do?
A day in the life of a medical billing professional
Your duties as a medical biller may include:
- Creating and submitting medical claims to patients and insurance companies, ensuring accuracy and completeness.
- Checking patient insurance coverage and eligibility before billing.
- Following up on unpaid claims and initiating appeals for denied ones within standard billing cycle timeframes.
- Handling patient inquiries about bills, offering explanations, and setting up payment plans for those unable to pay in full.
- Collaborating with medical coders and other healthcare professionals to ensure accurate billing and to resolve discrepancies.
- Navigating and maintaining electronic health records (EHR) and billing software, posting payments to patient accounts.
- Calling insurance companies for updates on claim status and to clarify billing details.
- Adhering to HIPAA regulations, ensuring patient confidentiality at all times.
- Staying updated on healthcare regulations, medical terminology, and coding practices.
- Tracking, reviewing, and reporting on billing metrics, trends, and periodic audits to ensure compliance and accuracy.
Skills required to work as a medical biller
- Proficiency with computers and medical billing software
- Knowledge of ethical debt collection practices and insurance guidelines
- Understanding of primary code classifications: ICD-10-CM, ICD-10-PCS, CPT and HCPCS
- Communication skills with patients/healthcare companies
- Basic accounting and bookkeeping practices
Medical billing certifications
| Certification | Offered by | Average salary |
|---|---|---|
| Certified Professional Biller (CPB) | American Academy of Professional Coders (AAPC) | $56,981 (accessed November 14, 2023) |
| Certified Professional Coder + Certified Professional Biller (CPC + CPB) | American Academy of Professional Coders (AAPC) | $56,290 (accessed November 14, 2023) |
| Billing Coding Specialist Certification (BCSC) | National Healthcareer Association (NHA) | $44,629 (accessed November 14, 2023) |
| Certified Medical Reimbursement Specialist (CMRS) | American Medical Billing Association (AMBA) | $53,000 (accessed November 14, 2023) |
Medical coding professional job overview
Medical coders are integral to healthcare systems, acting as a bridge between providers and billing. They translate healthcare diagnoses, treatments, procedures, and services into a standard set of number and alphabet codes from patient records. These codes are used for billing, insurance reimbursement, and medical research purposes. But, what does a medical coder’s typical day look like?
Cracking the code: what does a medical coding professional do?
The duties and responsibilities of a medical coder can include:
- Analyzing medical records, doctor’s notes, and other patient information.
- Converting diagnoses, treatments, and procedures into universal medical alphanumeric codes.
- Double-checking codes for correctness and ensuring they meet federal regulations and insurance standards.
- Working with physicians or other providers to clarify diagnoses or procedures for accurate coding while ensuring the security and confidentiality of patient information as mandated by HIPAA.
- Staying informed about coding guidelines and changes in the medical field, often through continuous training.
- Assisting in internal or external audits by providing necessary coding documentation or clarifications.
- Working with billing staff to ensure that coded data is integrated properly into the billing process.
Skills you’ll need as a medical coder
- Knowledge of medical terminology related to diseases, treatments, anatomy, and physiology
- Familiarity with the main coding systems, including ICD, CPT, and HCPCS
- Ability to spot inaccuracies or inconsistencies in medical records and ensure precision
- Capacity to interpret and understand complex medical information from patient records
- Ability to work with electronic health record (EHR) systems, coding software, and other relevant computer programs
- Being an effective communicator with patients, providers, and insurance agents
- Insight into how insurance companies work and the billing process, ensuring codes align with reimbursement requirements
Certifications
While certifications aren’t necessarily required to work as a medical coder, your potential earnings are significantly higher than without.
| Certification | Offered by | Average Salary |
|---|---|---|
| Certified Medical Insurance Specialist | Medical Association of Billers | $62,034 (accessed November 14, 2023) |
| Certified Medical Office Manager | Practice Management Institute | $66,000 (accessed November 14, 2023) |
| Certified Coding Associate (CCA) | AHIMA (American Health Information Management Association) | $43,548 (accessed November 14, 2023) |
| Certified Coding Specialist (CCS) | AHIMA | $55,763 (accessed November 14, 2023) |
| Certified Coding Specialist Physician-Based (CCS-P) | AHIMA | $74,000 (accessed November 14, 2023) |
| Certified Professional Coder (CPC) | AAPC (American Academy of Professional Coders) | $58,895* |
| Certified Outpatient Coder (COC) | AAPC | $64,267* |
| Certified Inpatient Coder (CIC) | AAPC | $58,730* |
| Certified Professional Coder-Payer (CPC-P) | AAPC | $62,494* |
| Certified Risk Adjustment Coder (CRC) | AAPC | $64,192* |
| Certified Professional Medical Auditor (CPMA) | AAPC | $72,304* |
| Ambulatory Surgical Center Coder (CASCC) | AAPC | $59,717 (accessed November 14, 2023) |
Sources, accessed November 14, 2023: * https://www.aapc.com/tools/medical-coding-salary-survey/
How much do medical billers and coders make per hour?
The average hourly wage is $23.45 or $48,780 per year according to the BLS (Source, accessed August 26, 2024: https://www.bls.gov/ooh/Healthcare/Medical-records-and-health-information-technicians.htm). Your earnings are impacted by your geographical location and your level of education and certifications earned.
Do I need any formal training or certification to become a medical coder or biller?
While you don’t necessarily need any formal education or certifications to get a job as a coder or biller, it can help. If you have little to no healthcare or medical records experience, getting a job as a biller or coder may be challenging without any prior training or education.
An online medical coding and billing program can be a great way to prep for certification as a medical coder or biller.
What are the minimum qualifications for getting a job as a medical billing or coding professional?
The minimum qualifications for medical records positions are a high school diploma or equivalent along with some basic medical knowledge, computer literacy, and attention to detail.
Is medical billing and coding a job you can do from home?
You can potentially work remotely as a medical billing or coding professional. In fact, 51% of medical records professionals work from home (Source, accessed November 14, 2023: https://www.aapc.com/resources/medical-coding-work-from-home), and that number grows every year.
What is my earning potential as a medical billing or coding professional?
Without a certification and only a high school diploma, earnings will likely be an average of around $47,000 annually. When you obtain a certification, your potential earnings can jump $11,000 per year to $58,055. With each certification you earn, your salary can potentially increase too! A billing or coding professional with three certifications can possibly earn up to $70,000 per year. With this type of position, the more experience, years, and certifications you have, the more you may be able to earn. (Source, accessed November 14, 2023: https://www.aapc.com/resources/medical-coding-work-from-home)
How long does it take to become a certified medical coder or biller?
It can vary by certification and how much time per week you are able to commit to studying. Then, you have to register and take certification exam. Since this can all be done online, you can work at your own pace and finish your medical billing or coding course on your schedule. Once you pass the exam, you will be given your certificate.
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Is medical coding a good job?
It isn’t a fit for everyone, but if you have the right personality and skillset, you can enjoy the stability, flexibility, opportunities for advancement and income growth, without having to spend four years earning a college degree.
Charting your future with CareerStep
Medical billing and coding is a valuable field. With CareerStep’s Medical Coding program and online Medical Billing Certification Program, you can get a good start and consistent support. Whether you’re just starting out or looking to advance, we’re here to help. Start on your journey toward a new and fulfilling career path with CareerStep. Call us at 1.800.411.7073 today.
