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.
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 consists 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 claim is denied by the third-party payer, the medical billing specialist must investigate the claim, verify its information, and update the database.
These two roles are often filled by the same person, especially in smaller clinics. However, they can also be separate positions within the facility. Medical billing and coding specialists are also responsible for dealing with collections and insurance fraud.
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.
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
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
Most medical billers and coders are employed by hospitals. 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, 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 take place in the form of phone conversations, email and mailings.
Medical billers and medical coders usually work normal business hours, with occasional overtime and weekends.
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.