Problem Solvers: What is a Medical Billing and Coding Specialist?

What Does a Medical Billing and Coder Do?  

Do you have an eye for detail and a love of organization? Are you interested in healthcare but don’t want to be on the front lines? Well, then maybe becoming a medical billing and coding specialist might be the right profession for you!

A medical billing and coding specialist ensures billing errors are not made. They also make certain their employer follows all rules and regulations associated with medical billing. To do this, a standard set of codes is used for each medical service provided. This helps prevent healthcare providers from losing billions of dollars each year to billing mistakes. As a medical billing and coding specialist you play an important role in the healthcare system.

3 female medical billing and coding students at Centura College smile underneath their masks. Sitting at a table with laptops in front of them.

 

What is a Medical Billing and Coding Specialist?

A medical billing and coding specialist uses their knowledge to identify and categorize the multitude of services that are provided in a healthcare office or hospital. This can include medical tests, diagnoses, treatments, surgeries, and other healthcare-related procedures. It is the specialist’s job to ensure that each of these items is coded correctly. This ensures that the insurance companies and the patients are billed accurately for the services they received. A medical billing and coding specialist is a crucial part of any healthcare team for both the office/hospital and for the patients themselves. A typical day for a specialist may include the following tasks:

  • Transcribing information into proper codes which are assigned to specific services, diagnoses, treatments, and procedures.
  • Preparing and sending invoices and claims for services rendered.
  • Correcting errors or information on rejected claims.
  • Tracking payments made to patient accounts.
  • Following up on outstanding bills with patients and insurance companies.

Essentially, the medical biller and coder acts as a liaison between their employer and insurance companies, including government agencies that process healthcare claims.

What Knowledge is Needed?

To become a medical biller and coder, you

must understand how to precisely translate medical services into insurance codes. You will need to have the following abilities and knowledge:

  • An ability to interpret both medical and insurance terminology.
  • A strong aptitude in medical codes.
  • An understanding of the importance of code accuracy (so the facility is not charged with fraudulent billing practices).
  • Knowledge about patient privacy, medical ethics, and HIPAA laws.
  • A comprehension of the claims and appeal processes.

Centura College’s Medical Billing and Coding Diploma program can help you gain this knowledge and will prepare you to succeed in the field.

What is the Difference between Billing and Coding?

It is a common belief that medical billing and coding are the same jobs. However, they involve two different job functions, both with their own responsibilities and tasks. While there is a lot of overlap, there are some distinct differences:

Medical Coding

A medical coder transcribes a practitioner’s notes and then converts them into codes for record and billing intents. These codes are sent to insurance companies so they can approve or reject a claim based on the codes used. Codes are industry standard and must be precise. A failure to code correctly could result in non-payment or fraud allegations.

Medical Billing

Once coding is complete, the billing specialist generates invoices and sends claims to insurance or other expense agencies for payment. Medical billers also determine co-payment amounts to collect from patients. Billing specialists will collect payments from insurance and, if applicable, bill the patient for amounts not paid for by insurance. Even though specialists are not transcribing code, they must be thoroughly familiar with medical codes so they can verify and correct codes if a claim is denied.

Small offices or facilities will often hire one person to perform both jobs while larger entities will typically separate the two. It is important to understand the role associated with each, how they differ and where they overlap.

Who is the Right Person for this Type of Job?

Being a medical biller or coder requires both hard and soft skills. Ideally, specialists should have the following traits:

  • Ability to multitask.
  • Be detail oriented.
  • Strong organizational skills.
  • Basic math abilities.
  • Computer skills.
  • Good communication skills.
  • Work well under pressure.

Both billing and coding specialists must routinely interact with medical staff, insurance representatives, patients, and others, some of which may be upset or frustrated. So, an ability to stay calm under pressure or in tense situations is imperative. General customer service skills are also great to have to be a successful specialist.

Where can you work in Virginia?

Medical billing and coding is considered by the U.S. Bureau of Labor Statistics to be a rapidly growing occupation when compared with other occupations. It is anticipated that 29,000 new jobs will be added in this field by 2029. Graduates who possess a medical billing and coding diploma will find a variety of places to work in Virginia. The Commonwealth is home to numerous doctor’s offices, urgent care centers, and top-notch hospitals and university medical centers.

About Centura College

Centura College has been part of an organization dedicated to helping men and women develop careers since 1969. By training working adults in healthcare, technology, business, and trades, they connect communities with some of the fastest growing career fields in today’s marketplace. The school offers professional facilities, knowledgeable instructors, day or evening classes, job placement assistance and is accredited by the Accrediting Commission of Career Schools and Colleges (ACCSC). To learn more, visit www.CenturaCollege.edu or like them on Facebook at https://www.facebook.com/centura.edu.

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