Medical billing and coding specialists are the financial heroes behind successful medical offices, deciphering complex billing and insurance issues so doctors and hospitals get the revenue they need to keep the lights on. If you’re ready for a new career, a vocational school medical billing and coding program can help you secure your future in a thriving field.
What Does a Medical Billing and Coding Specialist Do?
Medical billing and coding specialists manage administrative tasks related to health insurance claims. They participate in billing and other financial activities, including:
Transcribing Medical Information into Billing Codes
Almost all healthcare bills in the United States are paid for by a third party. Insurers need large volumes of data to determine if claims are covered. Billing and coding specialists condense pages of information by translating key parts of it into alphanumeric codes that describe everything from symptoms and treatments to medical equipment and supplies.
Team members review charts, identify the pertinent information, and assign the codes necessary to create a single insurance claim form. It’s an efficient but meticulous process requiring accuracy and attention to detail.
Obtaining Insurance Preapprovals for Healthcare Services
There are dozens of health insurance companies and hundreds of different plans. It’s not uncommon for patients to be confused about what their policy covers. Doctor’s offices work with insurers directly to review coverage before services are rendered so that patients understand their financial liability. Medical billing specialists coordinate the process so physicians and clients can make informed treatment decisions together.
Troubleshooting Rejected Claims
Some insurance claims are initially rejected, usually due to errors or insufficient information. Medical billing specialists review denials daily to determine why claims weren’t paid, revising and resubmitting forms to speed reimbursement. Cash flow is critical to the operation of medical facilities, so prompt deposits are a must.
Posting Cash and Insurance Payments
Medical billing is complex. Every bill generated may require several adjustments. Copayments made by clients on the day of a visit must be posted while payments from insurance companies are verified and, like a checkbook, reconciled. Remaining balances minus early payment and negotiated discounts, a provider’s agreement to charge a single client the same rate insurance companies pay, are then billed to patients. Interest and late fees on overdue balances may be applicable.
Medical billing and coding specialists also assist with a broad range of light accounting tasks, from handling cash deposits to running financial reports. They’re the glue that binds the financial and medical parts of healthcare together.
Are Medical Billing and Coding Specialists in Demand?
Demand for medical billing and coding specialists is growing. According to the U.S. Bureau of Labor Statistics, jobs for medical billers is expected to grow 8 percent in the coming decade. Why? The healthcare system is expanding. Millions of baby boomers are reaching retirement age, and it’s creating a perfect storm. The same support specialists who are retiring are also becoming more significant medical consumers.
Where Does a Medical Biller work?
Billing specialists work anywhere medical bills are generated or processed, including:
Hospitals
Hospitals are the largest single biller of healthcare services. The majority of claims are handled electronically between the insurer and the facility for a quick turnaround. Forms must be accurate and contain the data necessary to make quick coverage decisions.
A medical billing specialist working in a hospital is likely to be one of many and will be engaged in a narrow range of tasks. Billing and coding are technically two different functions, so it’s not unusual for specialists to do just one or the other in a large institution. Hospitals are a fast-paced environment with room for professional growth, and with experience, potential for advancement.
Private Practices
Doctors employ medical billing specialists to manage insurance claims. Compared to hospitals, services are limited in scope, so administrative staff are more likely to be generalists, handling transactions from start to finish instead of just one part. Tasks are comprehensive, but the pace is relaxed. It’s a perfect setting for new graduates to learn the ropes.
Medical Billing Services
Private practices can hire medical billing specialists or outsource the work to third-party services. Both approaches have pros and cons, but billing companies are growing in popularity because they’re efficient. Demand for top talent is high.
In this setting, medical billers will process large volumes of insurance claims for dozens of practices. It’s a busy environment similar to a hospital, but staff has the support of other team members and highly experienced managers. These positions are ideal for people who enjoy accounting.
Insurance Companies
Every claim an insurer receives is reviewed for accuracy and evaluated for coverage before payment is issued. A medical billing specialist’s job is to cross-reference requests for reimbursement with patients’ policies to determine the company’s liability. Identifying errors is a significant part of the job, so being detail-oriented is a plus.
Long-term Care Facilities
Nursing homes and assisted living centers hire billing and coding specialists to manage claims for medical and long-term care services, the policies and coverage differ. A broader range of coding systems are used, so it’s a challenging role requiring collaboration with multiple insurers and healthcare professionals. Since most senior homes also help patients manage their finances, there’s additional responsibility as a budget advocate.
Public Health Departments
Public health organizations use medical codes to track disease. Medical billing and coding specialists employed by the government gather and analyze coded data, compiling reports that help officials better understand health trends in the community.
In the early months of a pandemic, this information helped authorities monitor the outbreak and allocate supplies where they were most needed. Graduates with an aptitude for science and statistics are always in demand.
Who Does a Medical Billing and Coding Specialist Work With?
Medical billing and coding specialists work with patients, providers and insurers to secure the best financial outcomes, but who they interact with most depends on where they work.
In a hospital, most of a billing specialist’s time is spent working with administrative colleagues and supervisors. But since coding requires extracting data from health records, they also interact with clinical staff, doctors, nurses, medical assistants and diagnostic technicians, to clarify information whenever necessary. A select group engages with the public, answering questions, assisting with payment arrangements and investigating billing errors, but most work behind the scenes.
Medical billing specialists in a doctor’s office will have more contact with clients, insurers and medical staff. Most pre-authorizations are obtained before patients are hospitalized, requiring coordination with all parties. Everyone works as a team to get the billing process started before the patient arrives, so they know what they’ll owe before the visit. Worrying about unexpected bills is a significant source of stress.
Specialists working for billing services have the least contact with the clinical end of medicine, working more with financial management professionals from auditors to accountants. Contact with clients is usually via telephone only.
In a public health department, coders work with scientists, researchers and government officials. It’s an interesting window into the importance of public health measures.
Final Thoughts
Medical billing and coding specialists are the cornerstone of the healthcare industry, without them, medicine grinds to a halt. Vocational school programs are lifestyle-friendly and create workforce-ready graduates in months, not years. An influx of new patients means demand is high, so there’s never been a better time to train for this rewarding career.
Did learning about the demand for medical billing and coding specialist interest you? Ready to attend Medical Insurance Billing & Coding program at Meridian College? Medical Billing and Coding professionals are responsible for keeping the records, charts and bills in a medical office in order. In addition to the classroom experiences, students will also complete an externship for on-the-job training that will bring them further expertise. Contact us to learn more about.
Contact Meridian College today to learn more about becoming a medical billing and coding specialist.