Friday, January 26, 2024

The job role of medical billing and coding

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Do you know Medical billing and coding is one of American’s fastest-growing job roles? These employees are classified as medical secretaries by the U.S. Bureau of Labor Statistics (BLS). Approximately 22% of employees will grow in this field over the next 4 years. 

With a population of over 46 million Americans aged 65 and over, it is expected to double by 2060, with 68 percent suffering from two chronic diseases and the need for workers in the healthcare industry will not abate any time soon.

However, many more people who work in hospitals, medical offices, and other health care settings are allowed to see doctors. Medical billing and coding are two examples of such responsibilities. Let’s move on further to more details of the job rolling and medical billing and coding.

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What is Medical Billing and Coding?

Medical billing and coding are two interconnected occupations that aid in the payment of health care providers, insurance companies, and patients.

Doctors or office managers may undertake medical billing, insurance, generate patient invoices, those duties in addition to their other obligations, or they may appoint one or more staff members to do so. Do you think it is more affordable? 

Don’t you think it would be worth it if there was another occupation for those duties? Any medical facility requires someone else to handle medical coding and billing for insurance and patient bills. 

Medical billers and coders manage main duties with their healthcare providers. A coding and billing expert assists the healthcare facility in the management of insurance claims, invoices, and payments. A medical coding and billing consultant’s day-to-day responsibilities include the following: 

  • Creating and submitting invoices or payment claims
  • Resolving Rejected Claims
  • They provide proper coding of services, procedures, diagnoses, and treatments
  • Payment tracking
  • Tracking up with patients and insurance companies on outstanding bills

A medical coding and billing expert will spend a significant amount of time at the computer analyzing, inputting, and updating data.

Medical Coders

Medical Coder

Medical coding is the process of translating a provider’s diagnostic and procedure notes into the appropriate codes for record-tracking and billing reasons. 

Health care providers, hospitals, and insurance companies use these codes to establish a record of a patient’s visit and submit an insurance claim. Each code has specific rules for how it should be used, so accuracy is important.

Every injury, diagnosis, treatment, and medical procedure is described in these codes. This is essential for the patient’s medical records, the doctor’s office or hospitals, and the insurance claims processing. 

The medical coder acts as a translator for each of these organizations, keeping track of what transpires during a patient visit.

It is critical for the medical coder to correctly transcribe the visit record. Because each code has its own set of principles and regulations regarding the sequence in which they should be placed. If the coding is done improperly or erroneously, it might have an effect on the function of the insurance claim.

Medical Corder Role 

  1. Examine and evaluate clinical reports and patient records
  2. Use the CPT, ICD-10-CM, and HCPS Level II categorization systems to convert diagnoses and medical information into codes.
  3. Engage with physicians and assistants to confirm that codes are correct and ready for processing into a medical billing claim.
  4. Patient confidentiality and information security must be maintained.

Point of Coder and Biller Combine Their Duties

The medical coder compiles a record of your doctor’s visit using the coding rules outlined above. Each code corresponds to a disease, a medical office service, a prescription, or a test. The medical biller uses this document to file a claim to the insurance provider.

billing and coding are so interconnected, most medical offices hire coding and billing experts who are trained to do both tasks. 

While some bigger institutions will engage separate teams to handle billing and coding, this personnel usually work closely together to ensure the procedure is completed appropriately. The most critical element is to minimize coding and billing mistakes so that payments are collected on schedule.

Medical Billers

Following the completion of the coding, medical billing professionals prepare bills and submit claims to patients’ insurance carriers. That means the medical biller enters the coded transcript of the patient’s visit into specialized software. This information is sent as a claim to the patient’s insurance carrier.

 Insurance companies will accept or refuse payment requests based on these codes. Any balance not covered by insurance will be forwarded to the patient for payment.

The billing process frequently begins as soon as the patient schedules an appointment with the healthcare organization, as codes are recorded and sent to insurance for pre-approval. 

This assists in determining the patient’s out-of-pocket expenditures, which the office can bill the patient for at the time of the appointment. What does a medical biller do on a daily basis? Let’s move on further their role of the day to day life.

Medical Biller Roles

  • Obtain referrals and pre-authorizations from insurance companies for patient treatments.
  • Claims for patient procedures and treatments are audited and submitted to insurance companies.
  • Examine patient bills for the correctness and fill in any blanks.
  • Pay attention to the correctness of your payments.
  • To carry your work responsibilities, use medical billing software.
  • Discuss payment inconsistencies with insurance companies.
  • Investigate and appeal refused claims.
  • The update program to reflect rate changes.
  • Respond to phone calls from patients and insurance companies.
  • Examine your insurance eligibility and perks.
  • Understand insurance policies, including HMO/PPO, Medicare, and Medicaid.

Difference Between Medical Billing And Coding

We can categorize differences in medical billing and coding these main 6 factors:

Qualifications And Certification

Both billers and coders must complete the same educational requirements. Many businesses may prefer candidates who have a certificate or an associate degree in billing, coding, or both.

However, various industry certificates are available for each job. The following are primary certifications:

Work isn’t the same

Medical coders must first convert the treatment given to patients into codes that a computer system can understand. 

Medical billers then submit insurance claims and send payments to accounts based on the instructions supplied by coders. Medical information must be correct in order for claims to be reimbursed. Billers collaborate with insurance providers to resolve denials and rejections, finalize information, and send out statements.

Patients’ Interaction

Medical coding is a field in which you may truly assist patients without having to deal directly with them. Medical coders work behind the scenes with physicians, billers, and other personnel.

Patients must be communicated with by medical billers. Things don’t always go as planned, and it’s a biller’s responsibility to behave professionally and sympathize with patients who aren’t always happy to discuss charges they didn’t expect to spend. Billers who are effective assist patients understand their costs and are an important part of the entire healthcare experience.

Larger healthcare institutions divide responsibilities

Because of the increased need for billing and coding services inside bigger organizations, hospitals frequently hire professional coders and billers to carry out their specific tasks. Begin your hunt for your first entry-level employment in medical billing or medical coding at hospitals and other big healthcare institutions.

Salary and job prospects

According to the Bureau of Labor Statistics (BLS), Medical billers make an average annual income of $39,520 ($19.00 per hour). 

BLS forecasts a 10% growth in employment from 2018 to 2028.

According to the BLS, medical coders make an average annual income of $44,010 ($21.16 per hour). 

BLS forecasts an 11% growth in employment from 2018 to 2028.


If you are extroverted, the medical biller role is most suitable for you. Billers must be at ease on the phone while speaking with patients and insurance companies, as well as be able to communicate properly with a wide range of individuals and handle difficulties quickly when necessary.

If you are an introvert the medical coder role is most suitable for you. You could be more at ease with medical coding. Coders often work alone on a daily basis, with just occasional collaboration from other hospital personnel. This is usually a better alternative for analytical, detail-oriented students who are uncomfortable with the thought of chatting to strangers all day.

Do You Interest Next Step After Medical Billing and Coding?

  • Medical auditing specialist
  • Medical clinical data specialist

Even though these two choices are the most common, you may be interested in another profession within the healthcare industry where you may put your medical billing and coding knowledge to good use.

You may be interested in becoming a medical auditing specialist or a clinical data professional with extra schooling. Perhaps you want to be a medical transcriptionist or a medical and health service manager. Whatever professional path you select, your online medical billing and coding experience will help you get there.

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I am a medical biller, a blogger and have 20 years of experience in medical billing, medical billing management, and medical assistant. My background includes positions as a clinical medical assistant, medical records technician, medical office manager, biller, and coder. I am certified by the American Academy of Professional Coders (AAPC) as a Certified Professional Coder (CPC) and by the Practice Management Institute (PMI) as a Certified Medical Office Manager (CMOM). As an office manager/biller/coder, I was a member of the Michigan Medical Group Managers, Michigan Medical Billers Association. I also served as a committee member of the Michigan Osteopathic Association of Practice Managers Education Committee.

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