Medical billing and coding specialists are among the unsung heroes of the health care industry. They work behind the scenes to ensure that patients and insurance companies are properly billed for services and that providers are paid in a timely manner.
Medical billing and coding specialists are employed by:
- hospitals
- clinics
- private physician offices, and
- other settings supporting the industry.
In some instances, a single employee acts as billing and coding specialist for a provider. In larger health care settings, an individual specialist is often employed in each area.
The Medical Biller’s Role
The employee responsible for medical billing has the job of ensuring the provider is paid for services rendered, medications administered and supplies provided. A coder’s work demands that they apply skills in information management, interpersonal communication, accounting and computer technology. Coders must also possess knowledge of medical terminology and medical coding classification software. The job also requires familiarity with insurance forms and plans.
The biller uses these skills and knowledge to convert information from a transcribed patient medical record to a billing statement. They enter the patient data into the provider’s medical billing management system and ensure that statements for patients and insurers are compliant with the laws and regulations governing health information. Laws include the regulations established in 1996 by the Health Insurance Portability and Accountability Act (HIPAA) to address the electronic transfer of health data.
In addition to preparing statements, billers disburse statements to patients, insurance companies, Medicare, Medicaid or other parties responsible for payment. The biller also creates reports to track payment status and initiates follow-up on unpaid claims. When necessary, billers employ communication skills in serving as liaisons between the provider and insurer, or other responsible party, to guarantee the payment process proceeds successfully.
The Medical Coder’s Duties
The medical coding specialist’s work involves assigning a standard code to medical records for each procedure, medication or supplies provided to a patient. The coder uses problem-solving skills and critical thinking to analyze data in order to properly assign codes. To accomplish this, the coder employs knowledge of:
- anatomy
- physiology
- medical terminology
- etiology
- pathology
- treatment modalities, and
- prognosis of diseases.
Coders are tasked with the job of recognizing any irregularities in a patient’s medical record and must be able to use classification software to ensure coding accuracy.
Codes are used to identify billing costs. To assign the internationally accepted codes, the medical coder develops familiarity with the existing code systems accepted by the National Institutes of Health. Codes systems include the International Classification of Diseases (ICD) used to classify diseases and death certificates; Current Procedural Terminology (CPT) codes used to identify provider services; the Code on Dental Procedures and Nomenclature (CDT), the official codes for dentists; and others.
Your Place in the Medical Billing and Coding World
Some medical billing and coding specialists find a specific area within the field they especially enjoy. Opportunities exist in which the medical and billing code specialist concentrates skills and talents in areas such as cancer, mental health or dentistry. Others create careers as specialists working in medical documentation, electronic data interchange, collection or management. Whether employed in one of these specialties, or as both a coder and biller, the work is certain to offer challenges as the health care industry continues to adopt technology advances.
About our expert. Jan Jacobs has worked in medical offices since the early 1980's. Ms. Jacobs has worked for M.D.'s and D.O.'s in primary care and specialty care. She is employed as a senior medical biller and has been at her current job for nearly 10 years, where she uses three different billing systems.
