A medical coding and billing specialist is a person who provides essential healthcare communication between medical offices and insurance companies.
Medical billing and coding is a unique path for those interested in completing school in under a year to start working quickly. Although it is not a direct patient care position, those who choose this career help transmit essential information so patients can get the healthcare they need.
Ready to learn more? We put together this guide to provide you with the answers you need about a career in medical billing and coding.
Medical billing and coding professionals (CPCs) are specialists who act as a liaison between healthcare offices and insurance companies. Professionals in this career help medical facilities handle tasks such as:
Preparing and sending insurance claims
Creating and sending invoices
Following up with insurance companies and patients about past-due payments
Correcting rejected claims
Other essential administrative work
CPCs help translate your provider’s diagnosis and treatment into standardized codes. Then they send the codes to insurance companies and government agencies. The codes ensure that the treatment patients receive matches the insurance and government billing standards.
CPCs also help ensure that healthcare providers get reimbursement by insurance companies quickly and efficiently.
Medical coding and billing careers are primarily healthcare office jobs as opposed to direct clinical patient care positions. Most employees in this career work within a medical facility or office where patients go to be seen for medical care.
On a typical day, medical billers and coders spend most of their time working at a computer. Their area of expertise is reading, interpreting, entering, and updating patient healthcare information electronically. A solid understanding of medical insurance, how to code claims, and what to do if a claim is denied are essential components for success in this career.
Medical coding is the first step in recording patient data, both for patients’ medical records and for billing purposes.
Medical coders use intricate classification systems to translate medical information into codes that can be entered into billing systems and patient medical records.
These classification systems are ICD-10-CM, HCPCS Level II, and CPT, which we’ll discuss more below. This process allows everybody who touches a patient’s records to have a universal understanding of the patient’s diagnosis, as well as the tests and procedures that were ordered and delivered.
It is a medical coder’s job to make sure the correct code is identified and recorded.
Once a healthcare professional provides services to a patient, a bill needs to be submitted for payment. These bills get sent to insurance companies and government agencies as well as to patients. Bills must be accurate to facilitate quick payment.
Here are additional duties a medical biller may perform:
Read and review medical records — which may or may not have been coded — and translate them into a bill
Keep track of the bill to make sure it gets paid
Gather patient and insurance information before the patient sees a doctor or nurse
Ensure the patient has health insurance coverage
Gather preauthorizations, collect payments, and check billing for accuracy before submission
Record payments as they are received
Medical billers and coders have unique skill sets and responsibilities, and they are both categorized as “medical health information technicians.” Both positions also earn roughly the same income, although this can vary between facilities and locations.
According to the U.S. Bureau of Labor Statistics (BLS), the 2022 median annual pay for these professions is $47,180 or $22.69 per hour. The BLS also reports that the profession will grow 8% between 2022 and 2032, and there will be a need for 16,500 more professionals to fill positions during that time.
According to the American Academy of Professional Coders (AAPC), non-certified billers and coders make a median annual salary of $47,200 per year, while certified coders earn $63,085, which is 27% more. Adding a second certification increases that average salary to $$64,712.
Obtaining additional certifications is the quickest way to make more money as a medical coder and biller. In fact, some professionals in the industry have several certifications to help maximize their annual incomes!
It is also important to ask your employer about additional benefits that may add to your total income package. This may include:
Get a high school diploma or equivalent
First, you will need to obtain a high school diploma or GED equivalent. Some medical offices hire students right out of high school. However, to boost your chances of getting a high-paying job and obtaining career advancement opportunities, it will help you to attend a certificate or diploma program.
Enroll in a medical billing and/or coding program
There are two pathways to accomplish this:
The program and certification you decide to obtain will determine the length of your education. Medical billing and coding programs can take anywhere from one to three years to complete.
Earn a certification
You will have more success landing a great job and will earn more money if you earn additional medical and biller coding certifications.
Start job hunting
Get your resume ready and practice your interview skills! Many certificate and diploma programs have internal resources to inform you about job openings in your area.
Medical Billing classes will vary based on the program; however, students can expect to have a curriculum that will include coursework in:
- Advancing Coding Applications
- CPT Medical Coding
- Electronic Medical Records
- Healthcare Applications
- Health Information Ethics
- Introduction to Anatomy and Physiology
- Law, Ethics, and Confidentiality in Allied Health
- Medical Billing Technology
- Medical Coding
- Medical Health Insurance
- Medical Insurance Principles
- Medical Office Procedures
- Medical Reception
- Medical Terminology
Earning medical billing certifications can lead to better job opportunities, more responsibility, and higher wages. Some medical billing certs you can earn include the following:
The medical coding curriculum is very similar to the medical billing curriculum. In fact, most programs will only have a few differences. Expected coursework will include:
Advancing Coding Applications
CPT Medical Coding
Electronic Medical Records
Health Information Ethics
Introduction to Anatomy and Physiology
Law, Ethics, and Confidentiality in Allied Health
Medical Health Insurance
Medical Insurance Principles
Medical Office Procedures
Keep in mind that since many people work as both medical coders and biller coders, many people obtain certifications that can apply to both fields. Here are several medical coding certifications you may want to consider obtaining:
Medical coding and billing certification programs are available online or in person. Enrollment in either type of program offers its own advantages and disadvantages.
While learning in a traditional classroom setting gives students face time with an instructor and other students along with hands-on training, it also requires that you adhere to the institution’s schedule.
This may limit access for students who do not have a program nearby or who are pursuing their education while also working at another job or attending to family responsibilities.
By contrast, online medical billing and coding training programs offer scheduling flexibility allowing you to study when you are available as long as you complete your coursework. You can access programs anywhere without leaving your home, and these programs are often less costly.
But you give up access to face-to-face support from teachers and the comradery of interacting with fellow students, and you need access to technology and an internet connection.
Working as a medical records and health information technician — whether in billing, coding, or both — can provide both stability and flexibility. However, it’s important to note that some people do report having a difficult time finding their first job in the medical billing and coding profession, as many employers are looking for candidates with at least three years of experience.
Though you can work a typical 40-hour week in any type of medical facility, you may also be able to work as a freelancer in the comfort of your own home.
Typical work environments for medical coders and billers include:
- Doctors’ offices
- Educational institutions
- Government agencies
- Healthcare consulting services
- Insurance agencies
- Law firms
- Nursing homes
- Outpatient surgery centers
- University setting
Medical coders and billers can also work in less traditional settings. Many work for insurance companies, where they verify incoming insurance claims. Some work for law firms, interpreting medical records as part of insurance fraud investigations or within the scope of personal injury litigation.
Others work for government agencies, collating information that is used for setting national or local healthcare policy.
As of May 2022, the BLS indicated that there are 194,300 medical records specialists and health information technicians working in the United States.
Medical Biller and Coder Employment By Region
The five states with the highest level of employment of these professionals are:
California – 21,590
Texas – 19,750
Florida – 14,980
Pennsylvania – 9,600
New York – 9,130
The metropolitan areas with the highest levels of employment for these professions are:
Los Angeles-Long Beach-Anaheim, CA – 8,290
New York-Newark-Jersey City, NY-NJ-PA – 6,970
Dallas-Fort Worth-Arlington, TX – 6,180
Houston-The Woodlands-Sugar Land, TX – 4,280
Chicago-Naperville-Elgin, IL-IN-WI – 3,810
Medical Biller and Coder Salary by Region
The five states paying the highest annual mean wage for medical billers and coders are:
The five metropolitan areas with the highest annual mean salaries for medical coding and billing are:
Sacramento–Roseville–Arden-Arcade, CA – $73,810
San Francisco-Oakland-Hayward, CA – $73,800
San Jose-Sunnyvale-Santa Clara, CA – $71,090
Los Angeles-Long Beach-Anaheim, CA – $67,880
Stockton-Lodi, CA – $67,490
As you can see, there are many reasons to choose a career path in medical billing and coding. A small time investment can generate significant rewards, job security, and opportunities for growth and advancement.
For more specific information, the best resources are the professional organizations dedicated to advancing the profession. These are:
Competitive pay, flexible hours, and low barriers to entry — you can see why people want to become medical records and health information technicians.
Here are some other benefits we haven’t discussed yet:
- Medical billers and coders are valued and respected members of the healthcare team.
- Their work keeps revenue flowing into the organization and allows clinical staff to concentrate on providing patients with attentive care.
- The job offers tremendous flexibility in terms of work environment, including the ability to work from home as an online medical billing or coding professional.
- As the population continues to age, there are more and more people in need of healthcare, and many of those already working in the field are beginning to retire, so there are plenty of opportunities and job stability.
- Healthcare facilities are everywhere, so no matter where you want to live or what type of setting you want to work in, you are likely to find employers eager to hire someone with your skills.
- Once you’re in the field, you’ll find plenty of room to grow, either by moving into management or transitioning into a hands-on caring position like nursing.
- Perhaps most importantly of all, medical coders and billers perform work that can make a real difference in patient health and outcomes.
Though they don’t provide hands-on care, the information these professionals code and record becomes a vital part of the patient’s medical history. Physicians and other medical professionals rely on this information to maintain a reliable revenue cycle.
For additional Medical Billing and Coding information, check out: