Job Description

What are medical billing and Coding?

The medical billing and coding job description is more technical than some medical support careers and requires specific, learned skills. However, it is also an incredibly in-demand career and is one of the nation’s fastest-growing occupations.

This general job description will highlight the job duties of a medical biller and medical coder, including key responsibilities, work environment, and job requirements.

What Do Medical Billers and Coders Do?

The main role of medical billing and coding specialists is to ensure health providers are paid for medical services rendered. They are responsible for the accurate flow of medical information and patient data between physicians, patients, and third-party payers. Without them, healthcare businesses could not function efficiently.

Billing and Coding consist of two essential functions:

Medical Coding – Every medical service is assigned a numeric code to define diagnostics, treatments, and procedures. It is the medical coder’s job to enter this information into a the facility’s database using medical coding protocol to produce a statement or claim.

Medical Billing – The medical biller then acts as a liaison between the facility and payment parties. If the third-party payer denies the claim, the medical billing specialist must investigate the claim, verify its information, and update the database.

The same person often fills these two roles, especially in smaller clinics. However, they can also be in different positions within the facility. Medical billing and coding specialists are also responsible for dealing with collections and insurance fraud.

Medical Billing and Coding Job Duties

In general, professionals perform these job duties:

  • Reviewing medical procedures as documented by doctors
  • Translating medical procedures into codes that can be translated by payers, other medical coders, and other medical facilities
  • Transmitting coded patient treatment information to payers and other recipients
  • Coordinating insurance reimbursement of care providers
  • Handling patient billing

However, in some facilities these job duties are split into two individual job descriptions handled by two individuals.

Medical Coder Job Description

In facilities where medical billing and coding job duties are split between two individuals, the medical coder job description is more concerned with translating patient conditions and doctors’ medical treatments into universal medical codes for translation by various parties.

Medical coding specialists are responsible for job duties such as:

  • Reviewing patient medical records
  • Coding treatment information using Common Procedure Terminology (CPT) codes
  • Communicating with medical billing specialists to ensure treatment codes are accurately received

Medical Billing Specialist job description

When medical billing and coding duties are split, medical billing job duties consist of using CPT codes to assemble and coordinate reimbursement claims for third-party payers. Medical billers interact with insurance companies and with patients to ensure accurate, streamlined billing and payment.

Medical billers are responsible for job duties such as:

  • Receiving patient treatment codes to use in assembling reimbursement claims
  • Creating reimbursement claims and transfer to third-party payers
  • Coordinating reimbursement activities with payers
  • Billing patients for medical services

Medical Billing Specialist Education Requirements

Anyone entering as a billing specialist should have a GED or a high school diploma as a minimum qualification. In addition, a person applying for a higher position must have a professional certificate or degree. The degree or certificate may be in business administration, accounting or administration.

To use it for healthcare, you must have a training background and education on medical bills or Coding. Some of the certifications you take may include a Certified Professional Coder, Certified Professional Biller, and Medical Expert Specialist.

Medical Bill Specialist Salary Expectations

In 2022, a billing specialist earns an average of $ 16.66 per hour. These pay ratios are based on their level of education, ability, experience, and geographical location.

Anyone entering as a billing specialist should have a GED or a high school diploma as a minimum qualification. In addition, a person applying for a higher position must have a professional certificate or degree. The degree or certificate may be in business administration, accounting or administration.

To use it for healthcare, you must have a training background and education on medical bills or Coding. Some of the certifications you take may include a Certified Professional Coder, Certified Professional Biller, and Medical Expert Specialist.

Medical Bill Specialist Salary Expectations

In 2022, a billing specialist earns an average of $ 16.66 per hour. These pay ratios are based on their level of education, ability, experience, and geographical location.

Medical Billing and Coding Work Environment

Hospitals employ most medical billers and coders. However, they also work in other settings, including:

  • Physician Practices
  • Specialty Clinics
  • Surgical Facilities
  • Nursing Outpatient Facilities
  • Nursing Homes
  • Homecare Facilities
  • Insurance Providers
  • Medical Research Facilities

Medical billing and coding specialists usually work in office settings. A computer, a telephone, and appropriate documents are all used on a daily basis. This is one of the few medical professions where working from home is also possible.

Unlike other medical professions, the job description involves little contact with patients. Medical coders work closely with healthcare providers and insurance carriers to gather and provide accurate billing information, but most communication takes place in the form of phone conversations, email, and mailings.

Medical billers and coders usually work regular business hours, occasional overtime, and weekends.

Difference between a medical biller’s job and a medical coder’s job

Medical billers direct contact with patients and insurers, and medical coders work with records. Medical billers are tasked with checking invoices and account balances, and the job of the medical encoder is to enter data and classify treatments according to insurance classification. 

However, the medical billing profession and the medical coding profession are interrelated. That is, once a patient has received medical treatment, a medical coder performs the task of reviewing their records and assigning codes to generate billing information. Medical billers also file insurance claims using those codes.

Job Requirements

Although formal training in medical billing and coding is essential to become successful in this field, certain personal attributes will put you well ahead of the competition:

  • Discipline – Because it is such a competitive career, you must be driven and self-disciplined, especially if thinking of working from home.
  • Organization – Being organized is essential since you will be dealing with patient files and documents.
  • Detail Orientation – Attention to detail is also an important job requirement, as typos and inaccuracies can happen easily when using medical coding as a means of communication.
  • Phone Skills – Proper phone etiquette is necessary since phone conversations with patients and insurance carriers will be frequent.

Also see:

FAQ on Medical Billing and Coding

  • What are the qualities of an excellent medical biller?

A perfect medical billiard should have top clerical skills and good interpersonal relationships. Medical billers and coders must also deal with administrative and customer service matters. It is also essential for medical coders to be very careful as they need to remember the meaning of the codes.

 Medical billers should be able to diagnose any errors in the code or billing system. Also, they should be excellent listeners. This is because medical billers and coders need to respond to the questions of patients or insurance professionals. These professionals should have the ability to solve problems more patiently. 

  • What are the common skills in preparing medical bills?

The 8 Common Skills relevant to the Bill Expert have been redesigned for 2022.

      • Insurance companies – 18.1%
      • Medical Reports – 12.9%
      • Customer Service – 9.6%
      • Data Content – 8.9%
      • Medicaid – 5.0%
      • Bill Problems – 3.9%
      • Patient Accounts – 3.0%
      • Additional Skills – 38.6%
  • What are the leading medical bill liabilities?
      • Update patients’ medical information separately and accurately
      • Preparation and submission of billing data and claims
      • Preparation of bill invoices and documents for medical services and procedures