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Silicon Valley

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Medical Billing

& Coding

A SILICON VALLEY TECH COLLEGE PROGRAM

The medical billing and coding job description is more technical than some medical support careers, and requires specific, learned skills. However, medical billing and coding is also an incredibly in-demand career, and is one of the nation’s fastest-growing occupations.

This general job description will highlight the job duties of a medical biller and medical coder, including key responsibilities, work environment, and job requirements.

What Do Medical Billers and Coders Do?

 

The main role of medical billing and coding specialists is to ensure health providers are paid for medical services rendered. They are responsible for the accurate flow of medical information and patient data between physicians, patients and third-party payers. Without them, healthcare businesses could not function efficiently.

Medical billing and coding consists of two essential functions:

 

Medical Coding – Every medical service is assigned a numeric code to define diagnostics, treatments and procedures. It is the medical coder’s job to enter this information into a the facility’s database using medical coding protocol to produce a statement or claim.

 

Medical Billing – The medical biller then acts as a liaison between the facility and payment parties. If the claim is denied by the third-party payer, the medical billing specialist must investigate the claim, verify its information, and update the database.

 

These two roles are often filled by the same person, especially in smaller clinics. However, they can also be separate positions within the facility. Medical billing and coding specialists are also responsible for dealing with collections and insurance fraud.

 

Medical Billing and Coding Job Duties

 

In general, medical billing and coding professionals perform these job duties:

 

  • Reviewing medical procedures as documented by doctors.

  • Translating medical procedures into codes that can be translated by payers, other medical coders, and other medical facilities.

  • Transmitting coded patient treatment information to payers and other recipients.

  • Coordinating insurance reimbursement of care providers.

  • Handling patient billing.

 

However, in some facilities these job duties are split into two individual job descriptions handled by two individuals.

 

Medical Coder Job Description

 

In facilities where medical billing and coding job duties are split between two individuals, the medical coder job description is more concerned with translating patient conditions and doctors’ medical treatments into universal medical codes for translation by various parties.

 

Medical coding specialists are responsible for job duties such as:

 

  • Reviewing patient medical records.

  • Coding treatment information using Common Procedure Terminology (CPT) codes.

  • Communicating with medical billing specialists to ensure treatment codes are accurately received.

Medical Biller Job Description

 

When medical billing and coding duties are split, medical billing job duties consist of using CPT codes to assemble and coordinate reimbursement claims for third-party payers. Medical billers interact with insurance companies and with patients to ensure accurate, streamlined billing and payment.

 

Medical billers are responsible for job duties such as:

 

  •    Receiving patient treatment codes to use in assembling reimbursement claims

  •    Creating reimbursement claims and transfer to third-party payers

  •    Coordinating reimbursement activities with payers

  •    Billing patients for medical services

 

 

Medical Billing and Coding Work Environment

 

Most medical billers and coders are employed by hospitals. However, they also work in other settings, including:

 

  • Physician Practices

  • Specialty Clinics

  • Surgical Facilities

  • Nursing Outpatient Facilities

  • Nursing Homes

  • Homecare Facilities

  • Insurance Providers

  • Medical Research Facilities

 

 

Medical billing and coding specialists usually work in office settings. A computer, a telephone and appropriate documents are all used on a daily basis. This is one of the few medical professions where working from home is also possible.

 

Unlike other medical professions, the medical billing and coding job description involves little contact with patients. Medical coders work closely with healthcare providers and insurance carriers to gather and provide accurate billing information, but most communication take place in the form of phone conversations, email and mailings.

 

Medical billers and medical coders usually work normal business hours, with occasional overtime and weekends.

 

Job Requirements

 

Although formal training in medical billing and coding is essential to become successful in this field, certain personal attributes will put you well ahead of the competition:

 

Discipline – Because it is such a competitive career, you must be driven and self-disciplined, especially if thinking of working in medical billing and coding from home.

 

Organization – Being organized is essential since you will be dealing with patient files and documents.

 

Detail Orientation – Attention to detail is also an important job requirement, as typos and inaccuracies can happen easily when using medical coding as a means of communication.

 

Phone Skills – Proper phone etiquette is necessary since phone conversations with patients and insurance carriers will be frequent.

"Certified medical billing and coding specialists are also generally promoted more quickly and earn a higher salary"

Medical Billing & Coding Training

Training to become a medical billing and coding specialist is relatively quick and basic, as medical billers and coders are one of the few healthcare specialists who do not work directly with patients.

Medical billing and coding training programs, offered by career schools and junior colleges, are designed to prepare students to fulfill the basic job duties of medical billing and coding specialists by teaching the job skills and background knowledge needed to perform in this high-demand profession.

What Medical Billers and Coders Learn

The array of courses learned by medical billing and coding students is relatively diverse within the realm of healthcare, since these professionals work with many types of healthcare specialist. Thus, the medical knowledge coders and billers draw upon is broad. However, medical billing and coding training does not usually cover the hands-on procedures used by doctors and nurses. Instead, these training programs cover three primary areas:

  • Medical Fundamentals and Background Knowledge

  • Medical Terminology

  • Medical Coding and Medical Billing Practices

 

Medical fundamentals may include topics such as biology, anatomy, physiology, pharmacology and other life sciences that apply directly to healthcare. These courses give medical billers and coders the expertise to interpret physician procedures, conditions and reimbursement needs.

Medical terminology is the lexicon of words, suffixes and prefixes that describe the practices of medicine. It is a necessity for all healthcare professionals, and is used heavily by medical billing and coding specialists in their daily work, both in coding and in person-to-person conversations.

Medical billing and coding practices include the specific coding systems used by these professionals, and the specifics of working with insurance providers and other third-party payers. There are over 600 medical codes that describe various medical treatments and conditions, as well as many rules and regulations that apply to health insurance claims. Since medical billing and coding may or may not be split between separate individuals, most programs cover both coding and billing practices, though actual positions may focus more on one or the other.

Where to Get Medical Billing & Coding Training

Medical billing and coding training programs can be found at vocational schools and community colleges nationwide, or through online training programs. Classes are often lecture based, and some programs provide computer-based hands-on tasks that simulate medical billing and coding work.

The World Wide Web offers an array of training options which provide flexibility in scheduling. Using medical coding books for self-study can also help you prepare for this career, and for certification.

Benefits of Formal Training

Formal training in medical billing and coding is a major strength to have for becoming competitive in the job market. Since most employers prefer to hire specialists who have had formal training, graduates of medical billing and coding training programs are in a better position to be hired and promoted than those who are self taught.

Pursuing medical billing and coding certification after graduation is also highly recommended, since employers look for medical billing and coding specialists who are certified. Certification demonstrates to employers that a medical billing and coding professional is dedicated to career excellence and continuing education, making them extremely strong assets to a healthcare organization. Certified medical billing and coding specialists are also generally promoted more quickly and earn a higher salary.

Enroll in Billing & Coding Now
 

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