Do I Need a Degree to Become a Medical Billing Specialist?

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Many careers in healthcare require a college degree while others have flexible training requirements. The type of education you choose should reflect your long-term career goals. Not all programs are created equal, however, so it’s important to balance your personal and professional needs. For medical billing and coding specialists, vocational school diplomas are an excellent value.

Do I Need a Degree to Become a Medical Billing Specialist? 

A high school diploma is enough to land some medical billing jobs, but most positions worth having require a formal education. Some medical billing and coding specialists have degrees, but most opt to get vocational school diplomas.

Diploma programs offer:

A Comprehensive Education

The skills you learn in other jobs are rarely transferable to medical billing careers. Diploma programs cover an extensive range of topics related to billing and coding, preparing students with no healthcare background to tackle this critical role. You’ll have an advantage when competing against other candidates for choice positions.

A Career-Focused Curriculum 

Vocational schools offer a direct path to a medical billing and coding career. Programs are shorter because the curriculum is job focused. Students graduate in half the time it takes to get a degree while qualifying for many of the same positions as college-educated applicants. Earning a diploma is the most efficient way to launch a healthcare career.

Standardized Skills

Unlike on-the-job training, diploma programs are standardized. Students are familiarized with industry protocols and best practices, so graduates can meet any employer’s expectations. You won’t be limited in where you work because of knowledge gaps.

Hands-On Training

Vocational programs emphasize hands-on training. Students apply their knowledge to case studies, simulations, and real-world scenarios, practicing the skills they’ll need on the job. It’s a confidence builder.

Instructor Mentorship 

Transitioning from the classroom to the workplace is challenging. Learning from seasoned instructors, however, helps you bridge the gap between the educational and professional environment. As role models and mentors, they inspire students throughout their academic journey and beyond, providing insight into potential career paths and advancement opportunities.

Certification Preparation

Most employers prefer hiring certified billing specialists. Others ask new graduates to earn a certificate soon after being hired. Diploma programs help you prepare for the Certified Professional Coding exam through the American Academy of Professional Coders (AAPC) by aligning the curriculum with the test. On-the-job training can’t compete with the depth of knowledge you’ll gain.

Career Services

Vocational schools partner with healthcare facilities and medical offices to understand their staffing needs. These employers then turn to schools when they need qualified applicants. Students also have access to private job boards and networking opportunities, increasing their odds of getting their preferred type of job.

Advancement Potential

Training is the foundation of professional development in the healthcare field. Without it, it’s a long climb up the career ladder. A diploma positions you for faster career growth by preparing you for certifications and jobs with progressively greater responsibilities.

What Do You Learn in a Diploma Program?

Diploma programs are ideal for students with no healthcare experience. You’ll learn about the industry from the ground up, picking up unexpected skills along the way.

The curriculum covers:

Basic Computer Skills

Today’s students have basic computer skills, but office hardware and medical software are far more complex. Billing specialists need a broader understanding of workplace technology.

Programs explore:

  • Basic computer components — hardware, software, and operating systems
  • Keyboarding skills, including time-saving shortcuts for common tasks
  • Word processing programs, spreadsheets, and presentation software
  • Internet and intranet navigation — finding what you need online
  • Web browsers and internet security
  • Password and prompts
  • Email and communication tools
  • Organizing files and folders
  • Cloud storage — off-site, third-party data warehousing
  • Communicating with IT professionals

Students graduate feeling confident using computers and common workplace technology.

Medical Terminology

Medical terminology is the language of healthcare. This course focuses on how terminology impacts communication and billing and coding processes.

Topics include:

  • Term construction — combining prefixes, suffixes, and root words to create medical terms
  • Anatomical terminology and directional terms
  • Diagnostic terminology related to tests
  • Medical acronyms and abbreviations
  • Pharmacological terms and units of measure
  • Laboratory terminology

Students will analyze case studies to reinforce the application of medical terminology in real-world situations, practicing how to break down and decipher medical terms.

Anatomy and Physiology

Anatomy and physiology are the study of human body structure and function. Instruction is less in-depth than what direct healthcare providers need, covering:

  • Body structure
  • Major body systems
  • Organ functions
  • Breathing, gas exchange and oxygen transport
  • Elimination and excretion
  • Digestion and nutrition
  • The brain, spinal cord, and nerves
  • Physiological processes, including biological and chemical reactions

This basic overview helps billing and coding specialists better interpret medical documentation and select appropriate diagnostic codes.

Pathophysiology

Pathophysiology is the study of how diseases develop, their causes and their consequences.

Students discuss:

  • Normal and abnormal physiology
  • Cellular and tissue adaptations
  • Common medical conditions and treatments
  • Pathophysiology processes such as hypertrophy, dysplasia, and atrophy
  • Inflammation and the immune response — how the body reacts to injury
  • The role of genetics and environmental factors in disease development
  • Cancer and oncology — the pathophysiology of cancer, including cellular changes, tumor growth, and metastasis

Working knowledge of pathophysiology helps billing and coding specialists understand the rationale behind diagnostic and medical procedures, improving their coding and communication ability.

Medical Insurance

Insurers cover a majority of US medical bills. It is to these companies that you’ll submit claims as a medical billing and coding specialist.

This course covers the intricacies of the medical insurance system, including:

  • Types of health insurance plans, including fee-for-service, health maintenance organizations (HMOs), and preferred provider organizations (PPOs)
  • Private versus public insurance
  • Military and government-sponsored plans
  • Scope of coverage and preventive care benefits
  • Service pre-authorizations
  • Paper and electronic claim form formats
  • Claim submission and processing
  • Coordination of Benefits (COB) among financially responsible parties
  • Claim rejections, appeals and denials
  • Patient responsibilities — co-payments, deductibles, coinsurance and non-covered services
  • Alternative healthcare financing

Graduates are prepared to navigate a complex reimbursement system, better serving their clients and employers.

Electronic Health Records

Electronic health records are the digital equivalent of paper charts. Multi-functional, they’re a billing and coding specialist’s primary source of medical and billing information.

Topics in this course include:

  • The paper-to-digital record transition
  • Types of EHR software
  • Workflow integration — how team members work with data
  • Electronic health records (EHR) versus electronic medical records (EMR)
  • Record structure and navigation
  • Data entry guidelines
  • Record management systems
  • Clinical decision support systems
  • Health Information Exchanges (HIE) and interoperability
  • Data analytics, benchmarking, and reporting
  • Patient portals

Using software similar to what you’ll encounter on the job, you’ll practice finding, entering, updating and sharing data.

Introduction to Medical Billing and Coding

Core instruction kicks off with an overview of the principles, terminology and practices within the medical billing and coding industry.

You’ll examine:

  • The healthcare revenue cycle
  • Medical billing and revenue management
  • The purpose and benefits of standardized medical coding
  • Billing software and coding tools
  • The claims processing cycle
  • The importance of coding accuracy and quality control

Students come away with a broader understanding of their role in the billing and coding field.

Basic CPT/HCPCS Coding

The Current Procedural Terminology (CPT) and Healthcare Common Procedure Coding Systems (HCPCS) are among the most significant to the billing profession. Used to code professional services, supplies and equipment, they help generate revenue.

Concepts include:

  • The purpose and significance of CPT and HCPCS codes
  • Volume formats and organization
  • CPT and HCPCS coding guidelines and conventions
  • Code modifiers and their impact on reimbursement

Students use case studies to practice coding common services.

Basic ICD-10 Coding

ICD-10 codes cover symptoms, diagnoses, and medical conditions.

This course takes a deep dive into:

  • The role of ICD-10 codes in determining medical necessity
  • ICD-10 code formats
  • Navigating the ICD-10 codebook
  • ICD-10 coding in different settings
  • Common diseases and conditions subject to ICD-10 codes
  • External cause and place of occurrence codes

Mastering ICD-10 coding helps patients and providers maximize reimbursement.

Physician Office Billing

Medical billing and coding specialists manage the many components of physician office billing, from insurance verification to invoicing.

Students will study:

  • Billing workflow in private practices
  • Patient registration and insurance verification procedures
  • Charge entry and coding
  • Claims preparation and submission
  • Preparing invoices and billing statements
  • How to handle secondary claims
  • Payment posting and reconciliation
  • Accounts receivable management
  • Resolving rejected claims
  • Negotiating with insurers
  • Reimbursement analysis
  • Coding audit processes

You’ll get a feel for the entire physician billing process through simulations and case studies.

Medical Administrative Procedures

This course focuses on tasks that contribute to the smooth operation of healthcare facilities, exploring:

  • The structure and organization of medical facilities
  • Healthcare office operations
  • The administrative hierarchy and chain-of-command
  • Front-office versus back-office roles
  • Medical recordkeeping
  • Financial transactions and payments
  • Regulatory compliance and accreditation standards

Students graduate prepared for entry-level responsibilities in hospitals, clinics, and private practices.

Medical Law, Ethics and Professionalism

This course equips medical billing and coding specialists with the knowledge and ethical framework needed to navigate the moral complexities of their profession.

Topics include:

  • The legal and ethical frameworks that govern the healthcare industry
  • The role of regulatory bodies and government agencies in medicine
  • Patient privacy and confidentiality rules
  • Fraud and abuse prevention
  • Medical liability and malpractice
  • Cultural diversity
  • End-of-life issues
  • Healthcare reform
  • Professional communication
  • Conflict resolution

Program graduates are ready to function as valued professionals in medical settings.

Externship

Externships are practical learning opportunities. You’ll work in a healthcare setting under the guidance of experienced professionals who can answer questions, provide feedback, and offer insights into best practices. The experience is invaluable.

Medical Billing and Coding Capstone

A capstone is an end-of-program project that demonstrates your billing and coding expertise. Designed to integrate the knowledge and practical skills learned throughout the program, it’s the culmination of your learning experience.

Final Thoughts

While you don’t need a degree to become a medical billing and coding specialist, the benefits of a formal education can’t be ignored. A diploma is a foundation for the future.

Want to Learn More?

Ready to attend the 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 Meridian College today to learn more about becoming a medical billing and coding specialist.