Medical billing and coding specialists are the backbone of any medical office. They are a vital part of the administrative component of healthcare. Clinicians document each aspect of examinations, tests, procedures, and other services to memorialize the patient interaction and verify the rendered services.
The documentation is then passed along to medical coders, who transfer the narrative clinical information into a standardized form, which they submit to insurance carriers for reimbursement.
A medical coding career is ideal if you’re interested in healthcare but do not want a role that requires direct patient contact. Opportunities in the field will continue growing as our population ages and demand for healthcare rises. There is a clear path to employment with training from a vocational school.
What are the Core Duties for Medical Coders?
Medical coders, sometimes called medical billing specialists, complete various administrative tasks to secure payment for medical services rendered by physicians and healthcare facilities. Medical billing and coding specialists primarily work on computers, using multiple programs to review clinical documentation, create invoices using alphanumeric codes, and track a medical bill’s progress through the revenue cycle.
As a medical billing and coding specialist, you will also serve a quality-assurance role by overseeing clinician compliance with documentation standards. You will perform bill reviews to ensure compliance with internal policies and industry-wide regulations. You will also review rejected claims, research reasons for an appeal, and issue reconsideration requests to insurers.
Review and Interpret Medical Records
As a medical billing and coding specialist, you will review clinical records to ensure each documentation requirement is met, necessary signatures are present, dates are correct, and information is accurate. You will focus on compliance with institutional policies that govern the minimum standards of required documentation.
When you note omissions or errors, you must follow up with clinicians to obtain supplemental documentation or amendments. This duty protects patients because contemporaneous and complete records are necessary to ensure the continuity of care and that future treatment is safe and consistent with the patient’s medical history.
Code Medical Records and Generate Invoices
After you complete your record review, you will code the case. Each examination, service, procedure, and treatment corresponds with a standardized alphanumeric code. The codes are detailed and must be consistent with the medical record.
Effective medical billing and coding specialists are attentive readers and strong researchers. These skills ensure the codes they select are appropriate and justified by the available information. Insurers will reject codes that are unsupported by the clinical data. Coding will account for the majority of your time. You’ll have to work efficiently without sacrificing accuracy. Coding errors cause a ripple effect, leading to denied payments and the need to generate a new bill or appeal.
Submit Bills and Complete Follow-Up Tasks
You will transmit completed bills and supplemental medical documentation to insurance providers for remittance. The insurer then reviews the invoice and issues payment or a denial. You then track outstanding claims to ensure they were received, reviewed, and addressed. Due to the ongoing exchange of information between healthcare facilities and insurers, timely follow-up is necessary to ensure claims are not overlooked.
This role is crucial because medical claims are subject to strict filing and response deadlines. If payment is issued, you may be responsible for ensuring it is received by your employer. If a claim is denied, there is a small window in which you must research the reasons and issue an appeal to obtain the outstanding payment.
What is the Best Way to Start a Career in Medical Coding?
Medical coding is not a skill you can easily learn on the job or teach yourself. Performing the job effectively requires a comprehensive understanding of anatomy and physiology, medical terminology, healthcare reimbursement standards, federal regulations, and coding best practices.
Completing a comprehensive training program through a vocational institution is the best way to learn medical coding and secure a quality position at a medical facility. Schools teach the science needed to interpret medical records, how to code, and the fundamentals of medical billing. Vocational educators help you strengthen the communication, investigatory, and critical thinking skills needed to work alongside doctors and other healthcare professionals.
What Will I Learn in My Billing and Coding Program?
Your curriculum will blend practical skills with textbook learning to give you the knowledge and skills needed to be an effective medical billing and coding specialist. Instructors use case studies, simulated billing tasks, group work, and skills development exercises to prepare you to enter the workforce.
Billing Basics
You’ll learn the rules and standards applied by the government, insurance providers, and regulatory agencies concerning billing best practices. Topics will include HIPAA and privacy laws, the billing cycle, regulations and statutes, bill generation, understanding insurance plans, and denial appeals.
CPT, HCPCS, and ICD-10
Courses will cover the coding systems you’ll use every day. All bills have codes from the Current Procedure Terminology (CPT-4), Healthcare Common Procedure Coding System (HCPCS), and International Statistical Classification of Diseases and Related Health Problems (ICD-10). These globally used systems ensure consistency, transparency, and accuracy.
Rather than simply memorizing codes, instructors will teach you how to navigate the relevant manuals for research. You’ll develop strategies for quickly and accurately choosing appropriate codes.
Coding
The bulk of your work will involve each aspect of the coding process. Vocational education will help you understand how to code and explain the underlying theory behind each step. Coursework will involve learning to read and interpret medical records, how to understand insurance plans and their documentation requirements, code selection, and bill creation.
You’ll learn about different subsets of coding, allowing you to specialize in your career. The curriculum will include in-depth instruction on inpatient coding to prepare you for work in a hospital or skilled nursing facility. You’ll also learn how to code from operative reports, preparing you to take on complex surgical cases.
Health Information Technology
Vocational schools will prepare you for the workplace by introducing you to healthcare software and computer systems used in hospitals and medical practices. You won’t only learn to code, but you’ll complete mock exercises in real-world computer systems.
Instructors will also cover cyber-security and best practices, making you aware of potential threats and pitfalls to your success in the field.
Where do Medical Coders Work?
Completing a medical coding program offers you flexibility when selecting your job after graduation. Every healthcare provider needs someone to code and bill. As a result, well-trained and qualified medical billing and coding specialists can work in many settings. Each offers distinct advantages and challenges.
In general, medical billing and coding specialists work a typical Monday to Friday day shift. While you’ll be working in healthcare, your administrative duties will require you to be available when insurers and other agencies are open. Most positions are in a professional environment, separate from clinical care areas due to the sensitivity of protected health information.
Physician’s Offices
Doctors with independent practices or group practices operate much like a small business. Medical billing and coding specialists are an essential part of their team because they secure reimbursement so the practice can continue operating. These positions usually offer a consistent type of coding based on the doctor’s specialty, a volume of work based on the size of the practice, and a schedule that mirrors the provider’s office hours.
In this setting, you’ll likely handle every step of the billing process and may be responsible for accounts receivable, collections, and supervisory duties. You may also need to be in close contact with insurers to maintain effective working relationships and compliance.
Hospitals, Clinics, and Long-term Care, Facilities
Hospitals, urgent care clinics, specialized treatment centers, rehabilitation facilities, and nursing homes employ teams of medical billing and coding specialists. These are larger employers with multiple layers of supervision and management. You’ll work as part of a department to complete coding tasks.
You may specialize in one phase of the billing cycle or be assigned to a particular clinical department, completing billing and coding tasks from chart review to claim submission.
In these roles, you’ll perform inpatient and operative coding depending on how your department allocates tasks. You may also specialize and complete coding tasks for a specialty, like oncology or rheumatology. Their hierarchal structure may mean rigid policies and structured advancement opportunities.
Insurance Companies
Rather than generating bills for a healthcare provider, you may elect to review bills and issue determinations by working for an insurance company. You’ll review submitted invoices to ensure the codes match the narrative information. The tasks require the same skill set as working for a healthcare provider, but you process the claims in the opposite direction.
You’ll then select reasons for your approval or denial and transmit documentation to the healthcare provider. Insurance companies are large-scale employers. Beyond being a strong medical coder, you’ll need to become an expert on the insurer’s policies and coverage plans to make accurate claim determinations. You won’t interact with patients or clinical personnel like healthcare billing and coding specialists but collaborate with your peers and administrative staff.
Government Agencies
Medicaid, Medicare, and other governmental agencies, like the Department of Veterans Affairs and Department of Health and Human Services, employ medical coders to conduct bill reviews, compliance investigations, and audits related to accreditation and licensure.
Working for the government offers competitive benefits and relatively strong job security. You may work in an office or travel to healthcare facilities to conduct on-site investigations or reviews.
There are fewer opportunities with the government than with healthcare facilities or insurers. You’ll need strong coding skills that allow you to spot errors and fraud in billing as well as an in-depth understanding of laws and regulations.
Final Thoughts
Now that you know what medical coding is, it is time to learn more about the Medical Insurance Billing and Coding program at Meridian College. We prepare you for this rewarding and challenging career with an extensive curriculum and career services to help you find a job after graduation. Take the first step and learn more about Meridian College today.
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 us to learn more about.
Contact Meridian College today to learn more about becoming a medical billing and coding specialist.