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Medical billing and coding specialists work in one of the fastest growing occupations in America. These workers are medical secretaries in the United States. Included in the Bureau of Labor Statistics (BLS) category are: Overall, the sector is projected to see employment growth of 8% between 2021 and 2031, representing 53,600 new jobs. Demand is expected to increase with an aging population that requires more healthcare services.
Medical Billing And Coding Specialist Training
Every healthcare facility needs someone to do medical billing and coding for insurance and patient bills. Physicians or office managers may perform these tasks in addition to their other responsibilities, or they may assign one or more staff members to handle these tasks. Because clinical staff are focused on patient care, it often falls to trained specialists to handle the important administrative work of billing and coding to ensure that health care providers are reimbursed for their services.
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Does the idea of working as a billing and coding specialist appeal to you? Let's take a look at what it takes to make it in this fast-growing industry.
A billing and coding specialist helps the health center manage insurance claims, billing and payments. A Medical Billing and Coding Specialist's daily duties include:
Although these workers often work in the same health center where patients go for treatment, it is primarily office work rather than patient-facing clinical work. A medical coding and billing specialist spends a lot of time at a computer reviewing, entering and updating information.
Job descriptions often combine billing and coding into a single position. However, they are technically two different job roles, each with their own responsibilities and duties.
Medical Billing And Coding
Many healthcare offices will hire the same person to do both jobs, although larger facilities may split the job into two separate positions, so it's important to understand the differences between the two roles.
Medical coding is the act of taking a provider's diagnostic and procedural notes and converting them to the correct codes for record tracking and billing purposes. Codes are industry standard alphanumeric combinations used to identify the services provided and billed for. This will require knowledge of the different codes used:
Each of these codes is used in insurance billing and the coder must follow specific guidelines for correct use and placement in the billing software.
Codes can be entered while the patient is visiting. There will be codes for seizure type and patient-reported symptoms. Other codes will be applied to symptoms observed, tests and procedures performed, diagnoses and treatments recommended by medical personnel.
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After coding is complete, medical billing specialists prepare bills and submit claims to patients' insurance providers (or other payers). Based on these codes, insurance companies will approve or deny requests for payment. Any remaining amount not covered by insurance will then be sent to the patient for payment.
The billing process often begins with the patient's doctor's office visit, as codes can be entered and sent to the insurer for pre-authorization. This helps determine what the patient's out-of-pocket costs will be, so the office can charge the patient that amount at the time of the visit.
A medical biller must understand the industry codes even if someone else does the coding, because the billing specialist has to review the reasons for denied insurance claims and update the codes before resubmitting the claims. A medical biller will also verify that codes are entered correctly before submitting the initial claim.
Once the insurance billing has been settled, the remaining amount will be billed to the patient. This process also reaches the medical billing specialist. Medical billers also determine copayment requirements, track payments, and track payments due from insurance companies and patients.
Medical Billing And Coding Specialists: What Is Their Role In The Modern Healthcare System?
If a bill is not paid, the billing specialist will need to contact the insurance companies and make sure all the documents are in order. If a patient fails to pay an outstanding bill within a certain period of time and does not respond to other requests, the billing specialist may have to assign the debt to a collection agency.
Because the billing and coding processes are so intertwined, many medical offices employ billing and coding specialists with training to perform both roles. While some larger facilities will employ separate teams to handle billing and coding, these individuals often work closely together to ensure the process is done correctly. The most important aspect is to avoid billing and coding errors so that payments are collected on time.
While job titles and career descriptions for medical coding and billing specialists may vary, the basic requirements are often the same. Knowing the required codes is a common requirement, but there are other areas of knowledge that can increase your employability.
In order to code correctly, a basic understanding of medical terminology is essential. Includes anatomy and physiology terms, diagnostic and procedural terminology, etc. Understanding the most commonly used terms in the medical profession will help with the billing and coding process.
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You will need to be able to do basic arithmetic to determine the correct billing amounts. Although the billing system can automatically generate forms with the correct amounts for insurance claims based on the codes entered, you may need to calculate the amounts due from patients or set up payment plans when appropriate.
The medical billing and coding process requires a working knowledge of computer systems and related medical software. Ability to learn new programs is also a plus.
Part of the medical billing process may include contacting patients for payment. The ability to communicate effectively and professionally is essential to this aspect of the job. Some patients can become stressed, upset, or angry when faced with medical problems and a high bill, so good communication skills can help make these conversations a little easier.
In addition to the level of computer skills, a Medical Billing and Coding Specialist will need to be able to use other basic equipment such as a 10-key calculator, printer, copier, scanner, phone system, and the like. If you've ever worked in an office, you've probably used these tools.
How To Become A Medical Coder: Certifications, Salary, And Jobs
While not all employers require certification to land a job as a medical coding and billing specialist, having an industry certification, such as the AAPC's Certified Professional Coder (CPC®) credential, can make you stand out as a job candidate. in the field
Although work experience and other qualification requirements are required for full CPC certification, those who pass the certification exam but lack the required experience may receive the CPC Apprentice (CPC-A) designation. After showing proof of two years of work experience or 80 face-to-face hours of coding preparation course and one year of experience, a CPC apprentice can earn full CPC status.
The BLS reports that the median salary for a medical secretary, which includes medical billers and coders, was $37,450 a year in 2021. That means half of medical coding and billing specialists earn more than that amount and half make less.
The top 10% in this field earned more than $63,100 and may represent the salary level of those with the most work experience. The bottom 10% of earners in this field (lowest decile) earn an average of $29,040 and $13.96 per hour, which may indicate work experience closer to entry level. UMA graduates in the 2021-2022 cohort of its medical coding and billing programs reported to UMA that they earned a median hourly wage that is about or slightly above the BLS lowest decile.
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You can earn more as you gain experience in the field, especially if you move into senior or supervisory positions.
A medical billing and coding specialist requires good organizational skills. If you are a detail-oriented professional who is able to manage time well and handle multiple projects well, a job in medical billing and coding may be a good fit for you.
Candidates must also be comfortable in an office setting as the job requires a lot of time in front of a computer screen and working with patient files. It is important to have a good understanding of medical terminology, or at least be willing to learn it. Those working in this field will also need to keep abreast of changes in coding procedures and guidelines, so an interest in continuous learning is also a good quality for this role.
If this description sounds like you, training for a Medical Billing and Coding Specialist position could be an excellent career choice.
Questions Answered On Medical Billing And Coding Specialists
Billing and coding opportunities may be available to those without formal training or experience, but some medical offices may prefer experience or certification (or in some cases, both) in a billing and coding specialist. Earning a diploma or degree in medical billing and coding can help you gain the knowledge you need
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