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A Complete Medical Billing and Coding Guide 2023

Updated: Apr 27, 2023

The healthcare facility's insurance claims, invoices, and payments are all managed by a coding and billing professional. A medical coding and billing specialist's day-to-day responsibilities include properly coding services, procedures, diagnoses, and treatments. Creating and sending invoices or payment claims.

Medical Billing and Coding is a great career opportunity. Additionally, it's one of the few health care jobs that can be worked remotely.

This complete Medical Billing and Coding guide is an overview of all the information you need to know before deciding it's the right career path for you.

Let's get started!

What's Included in Becoming a Medical Billing and Coding Specialist?

Do you want to be involved in the medical field but are afraid to touch a patient? Are you squeamish but want to make a difference in people's lives?

A Medical Billing and Coding Specialist Program is definitely right for you. Becoming a medical billing and coding receptionist allows you to be involved in the medical field without having to physically interact with patients. Medical billing and coding specialists are important members of each medical facility that coordinates the communication, payment, and cooperation between the facility and insurance companies.

What is a Medical Billing and Coding Specialist?

Medical coding and billing specialists are considered medical secretaries that act as a connection between the medical office and insurance companies. They are responsible for keeping the operations of the office running smoothly. Clinical workers are focused on patient care and office duties are left for trained medical billing and coding specialists. The main responsibilities of a medical billing and coding specialist includes:

  • Process patient information, insurance claims and payments

  • Coding services, procedures, diagnoses, treatments, etc

  • Compose and forward invoices and claims for payment

  • Review and correct rejected claims

  • Communicate with patients and insurance companies with outstanding balances

  • Perform file system and database management

  • Manage a multi-line phone system

  • Prepare reports, invoices, and memos

Additional duties such as scheduling appointments, billing patients, compiling medical charts and records, and much more may be tacked on to a medical billing and coding specialists daily tasks. Medical billing and coding specialists work hand and hand with medical facilities, and are usually found in an office within the facility opposed to face-to-face with patients on the Unit. As a medical billing and coding specialist, it is expected to spend long hours on the computer, reviewing, editing, and updating medical data.

You may have also heard medical coding and billing specialists referred to as:

  • Medical Receptionist

  • Medical administrative Assistant

  • Medical Records Specialist

  • Health Information Technician

  • Clinical Coding Officer

  • Coding and Billing Analyst

Every medical facility needs a medical billing and coding specialist in order for their physicians to be reimbursed. Therefore, medical coding and billing specialists can be found in clinics, offices, hospitals, and anywhere else healthcare is performed.

Medical Billing and Coding Specialist Qualifications/Skills

A successful medical billing and coding specialist will have numerous office and people skills necessary to complete the job duties necessary. Someone considering pursuing medical billing and coding as a career should have outstanding verbal and written communication skills. Communication is one of the most important duties a medical coding and billing specialist has. Other qualifications or skills necessary for a potential medical billing and coding specialist include:

  • Multitasking

  • Prior knowledge of medical office procedures, regulations and terminology

  • Patience and discretion

  • Attention to detail

  • Decision making skills

  • Immaculate computer skills

  • Basic math skills

  • Use of basic office equipment like the printer//fax/copy machine

  • Phone etiquette

Use of these skills listed above will help any medical billing and coding specialist be very successful. Being able to combine one skill with another is also very important, as this allows you to stand out from the rest. As a medical billing and coding specialist it is most important to remember the tone of your voice. People are more willing to respond and work through an issue with someone who is empathetic to their situation.

The Difference between Billing and Coding

Although medical billing and coding are two different job functions, most smaller companies combine them into one job opportunity. Larger companies may decide to have two job positions, medical biller and medical coder. Both medical billing and medical coding each have their own job responsibilities and tasks that need to be done. Combining the job title allows for smaller companies to utilize less employees, since there will be less information to sort through. It is important to understand what differentiates medical billing from coding, and that they are two separate job functions.

Medical Billing

Medical billing specialists become involved once the medical coding specialist has completed their tasks. The medical billing specialist creates invoices and forwards them to the patient's insurance provider. Based on the codes provided by the medical coding specialist, insurance companies will approve or deny requests for payment. Any amount not covered by the patient's insurance will be billed to the patient by the medical billing specialist.

The billing process of healthcare begins right when an appointment is scheduled. This allows codes to be entered and submitted to an insurer for pre-approval. Pre-approval helps determine what the patient’s out of pocket costs will be for this appointment, and allows the medical billing specialist to charge the patient the correct amount at the time of the visit.

Like mentioned earlier, medical coding specialists and medical billing specialists have two different job functions, but they need to be able to understand one another's work. A medical billing specialist needs to understand medical codes because they have to review any reasons claims have been denied, and they may be responsible for correcting the codes and submitting the claim. Medical billing specialists also verify the codes before submitting the initial claim. Without knowledge of coding, medical billing specialists will be unsuccessful and inefficient.

Medical billing specialists are also responsible for sending invoices to patients once insurance billing is handled. Additionally the medical billing specialist is responsible for determining co-pay requirements, tracking payments, and following up on missing payments. If a bill goes unpaid, it is the medical billing specialists responsibility to contact the patient's insurance company and make sure the proper paperwork is in order. A medical billing specialist may have to get involved with a debt collection agency, if a patient has an outstanding bill and does not respond to communication.

Medical Coding

Medical coding is the act of taking a provider’s diagnostic and procedural information and converting them into codes for record-tracking and billing purposes. These codes are industry standard alphanumeric combinations used to identify the procedure being performed.

There are three types of codes used by a medical coding specialist:

  • Current Procedural Terminology (CPT) are codes that identify specific procedures and examinations performed.

  • International Classification of Disease (ICD-10) are codes that classify medical diagnoses.

  • Healthcare Common Procedural Coding System includes codes that are not covered by the previous two sections, including codes for specific mobile devices or supplies.

A medical coding specialist will use these different codes when billing insurance companies. The coder must follow specific guidelines for correct use and placement in the billing software being used.

Like mentioned earlier, codes can be entered as soon as a patient schedules an appointment. There are codes for the type of visit, symptoms reported by the patient. Then additional codes will be added once the patient is observed. Codes for symptoms observed by the medical staff, tests, procedures, diagnosis and treatment will be recorded.

Combing Medical Billing and Coding

The medical billing and coding processes are heavily intertwined with one another. Most medical offices look to hire medical billing and coding specialists with the ability and training to perform both job functions. Although some companies may split their medical billing and coding specialists into teams, these teams work together immensely to ensure the process is done correctly and as smoothly as possible. For medical billing and coding specialists it is most important to pay attention to detail, to avoid errors so payment can be collected on time.

The Benefits of being a Medical Billing and Coding Specialist

There are so many benefits of becoming a medical billing and coding specialist, including:

  • Jobs are available and in demand

  • Competitive salary

  • Several options to obtain the education needed

  • Quick certification process

  • Opportunity to advance

  • Work from home opportunities

  • Freelance and Contract opportunities available

  • Health insurance

  • Disability insurance

  • 401k or 401b saving opportunities

  • Paid vacations and sick days

The benefits of becoming a medical billing and coding specialist are endless.

How to Become a Medical Coding and Billing Specialist

There are several different routes one can take in order to become a medical coding and billing specialist. No matter what route you take there are the same few requirements which include:

  • Successfully complete an Online Medical Billing and Coding training course that is approved by the Board of Education

  • Be at least 18 years of age

  • Minimum of high school diploma or GED

  • Pass a Medical Billing and Coding certification program (exam is optional)

Not all medical billing and coding specialists may have different job requirements based on the needs of the employer. Almost all employers require a certificate/diploma program or an associates degree in medical coding and billing to be completed. Other employers require an industry certification as well their certificate/diploma program.

Job Opportunities for Medical Coding and Billing Specialists

Careers in the medical billing and coding industry can have several different job titles. These titles vary based on job responsibilities of that specific job opportunity. Most roles have the same general job duties but different titles based on the employer or the company. Some job options in the medical coding and billing industry are:

  • Medical Coding Specialist

  • Medical Records Coordinator

  • Medical Records Clerk

  • Medical Billing Manager

  • Health Information Technician

  • Medical Records Director

Management level careers in this field may require additional education and/or work experience.

Pay and Outlook for Medical Billing and Coding Specialists

Since the COVID-19 pandemic has made itself known, health care needs have increased a great amount. With the increase in demand for physicians, doctors, nurses, nurses aides, comes the demand for medical coding and billing specialists. It is projected there will be a 22% increase of employment of medical secretaries by the year 2026. This rate is much faster compared to other industries, and amounts to about 129,000 new job openings in the upcoming years. New Jersey currently has the highest medical billing salary in the entire country. The average medical billing and coding specialist in the Garden State can expect an annual salary of at least $54,000, which averages to about $25.00 an hour. With a combination of formal education, industry certification, and experience, your earning potential increases, as do your supervisory roles.

What Do You Learn as a Medical Billing and Coding Specialist?

As a medical billing and coding specialist you’ll learn how to use the three different types of coding systems; Healthcare Common Procedure Coding System (HCPCS) and the CPT Category II, and ICD-10 codes. Experience with hands-on medical billing and coding software will be gained. Technical knowledge, healthcare information, and background on business topics will also be learned throughout your experience as a medical billing and coding specialist.

Final Thoughts

Now that you have read through the amazing guide that goes along with Medical Billing and coding specialists, you can find the right program for you!

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