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Medical Billing and Coder in Brief
There are plenty of administrative jobs available in the health care sector apart from the numerous medical positions. One of the most sought after administrative position in medical field is the post of a medical biller and coder. Although, there is a slight difference between the job of a medical coder and a medical billing clerk, most often they are combined due to the similarities in their scope of work. The profession of medical billing and coding is an important position in any physician’s office of a medical organization. This administrative position is also a highly respected one and in short while of experience one can become obtain a permanent job and is also given the responsibility to train other professionals to enjoy the profession of medical billing and coding with a stable income. A medical billing and coding job is related to the allied specialties of health care occupation and is estimated to the among the top ten fastest growing job in the market. The two occupations are complementary but many individuals combine it into a single career.
Medical billing and coding forms an important element of the business operation in any kind of hospital settings be it a private physician’s office or a hospital. These administrative professionals are given the duty to sort out files and deal with a large amount of paperwork of the health care organization. They are involved in handling all kinds of insurance claims, insurance fraud and Medicare facilities. The job of medical billing and coding involves the professionals to keep all the gathered medical information confidential by keeping a record on a daily basis. This requires the professionals to be discreet with their work. Medical billers and coders are also responsible for collecting money from the patients for the services provided to them on behalf of the company. When patients visit the medical organization, their services are entered into the computer and coded for which an invoice is issued and given to the patient.
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A medical biller and coder prepare and submit insurance claims for the services it offers to its patients and these professionals form responsible to reimburse the patient’s money from insurance companies. They are also involved in analyzing and forwarding patient’s health condition statements which will help to identify and resolve the billing complaints of the patients. They answer all kinds of billing related queries that arise from the medical staff, patients and also the insurance companies. This professional must compile medical reports every time a patient is provided with health care services and this information is used for billing and insurance purpose. Later the records are organized and coded and stored in a computer for later revival.
A medical billing and coder professional is also known as a health information technician, health information coder, coding specialists or a medical coding specialist. A medical coder assigns unique standardized identifiers and codes classified by the International Classification of Diseases. These codes are helpful to identify the narrative descriptions of the health care procedures, diseases and injuries provided to the patient. And these codes become basis for billing and other administrative requests. They are also helpful for communication among the medical professionals who are responsible to provide patient care. In case an insurance company or a medical government agency issues a dispute against a medical bill, it forms the responsibility of a medical biller and coder to clarify the problem and claim for insurance reimbursement by sufficient communication through e-mails or phone calls.
Medical billing and coding administrative professionals can be employed with a number of institutions in a wide variety of environment settings. However, majority of these professionals are employed by large hospitals, nursing homes, government agencies, physician’s clinics, mental health care organizations and any other large health care business. This is one of the medical professions where professionals can get the opportunity to work from home as long as they have all the required resources. These professionals work closely with insurance companies, patients and other health care providers but most of the communication process does not happen face-to-face. They work for a particular period of work time and at times they are expected to work weekends or overtime in case the paperwork exceeds.
What are the duties and responsibilities given to a medical billing and coding position?
Duties of a medical billing and coding profession:
The position of a medical billing and coding job requires the professionals to perform all the more the same duties in any type of health care settings. However, the amount of work given to them varies. Let us read in detail about some of the basic duties assigned to a medical biller and coder as part of a health care organization:
- Medical Coding Duties: It is an important duty of this professional to gather information for the patient and assign codes to all the services provided to the patient. A medical billing and coding professional must enter all patient information to prepare a medical database in the medical organization. He must make sure that all the information provided in the medical report is true and correct by making use of medical procedures and terminology.
- Appealing for Insurance Claims: They are given the duty to makes all the necessary corrections in the insurance when an insurance claim is rejected by the insurance company. It forms the duty of the medical biller and coder to investigate on the rejected appeal of insurance of claim and to ensure that the information to entered correctly by making all the necessary changes. He must alter the information in order to match the creditability and requirements of the insurance money even if he requires him to prepare a new invoice for the services.
- Analysis of the Medical Bill: Another duty of this professional is to analyze the billed and coded information to ensure that everything is accurate and complete. These professionals require some additional information to complete the database of the patient’s medical record.
- Gathering information: An important and primary duty of a medical biller and coder is to spend plenty of time to collect and reconcile the information with the family members of the patient and the insurance company. They are involved in verifying the rules and regulations of the insurance company by explaining the insurance benefits and claims to their patients and what they can reimburse from their insurance policy.
- Ensure quick payment: It is the duty of a medical biller to check the progress of insurance appeals so that their patients receive prompt payment from the insurance companies. This duty requires them to communicate with the insurance agency that will let them know about the status of reimbursement for the medical services received by the patient.
- Submitting Claims: A medical biller and coder is involved in submitting the billed and coded medical information to the insurance agencies by preparing a report on the services given to the patient in order to claim for payment.
Responsibilities of a medical billing and coding job:
Following are some of the responsibilities of a medical biller and coder:
- Insurance Verification: This specialist is given the responsibility to make sure that the patient receives all the money under the insurance policy. For this purpose they must collect all the insurance data from the patient and verify it with the insurance agency. They also obtain pre-authorizations as and when required.
- Collections: These professionals are required to collect money from the past dues and balances from the patients by claiming to the insurance companies to find out the status of the payment and if the claim has been denied. In case a patient does not make his bill on time, this billing professional must make all attempts to collect the medical balances.
- Coding: A primary responsibility of this position is to place the correct procedural technology codes on the bills of the patients for the services provided to them. They are responsible to assign the codes accurately by representing the reason of their disease that gives them a reason to warranty for the medical procedure being performed.
- Billing: A medical biller and coder are given the responsibility to prepare bills both for the insurance company and the patient by specifying the amount due. Once the insurance agency has repaid back, this professional is responsible to send a statement to the patient about other remaining dues.
What are the educational qualifications to become a medical biller and coder?
The position of a medical biller and coder requires minimum amount of educational qualifications in order to state the career. However, skills can be learnt by acquiring experience in the profession. As it is a position related to administrative section math skills form very crucial for obtaining a job as a medical biller and coder. Formal education is sufficient for this position and makes you capable of working as a medical biller and coder. Following are the educational requirements to be a medical billing and coding professional:
Educational Requirements of a Medical Biller and Coder:
There are no specific educational training requirements to start a career as a medical biller and coder. Individuals interested in this field can obtain a two-year associate degree in this field. A Bachelor’s degree in this field is also very beneficial as it guarantees an employment with a high paying salary package. Students can also earn a diploma in field of medical coding. A diploma degree is very useful for students who already have a bachelor’s degree in non-related fields of medicine such as an Information Technology degree. With lack of skilled and well-qualified medical billers and coders, individuals with an associate degree too are able to obtain a high paying job.
Students might intern with experienced medical billing and coding professionals during their college education so that they receive on-the-job training experience and understand the profession better. An internship program is not compulsory and depends upon the syllabus of the university. However, this program proves useful as they add up to the credentials of being a medical biller and coder. The platform of an internship program allows the students to display their professional skills.
Certification and Licensure
What is the certification and licensure given to a medical biller and coder?
Apart from acquiring education, medical billing and coding professionals can acquire a certification and licensure. Although, certification is not mandatory on part of the professional, a certification certifies the educational qualifications of the student making him more competitive in the work environment. Certification forms one of the best way to demonstrate the high qualified standards of professionalism that is expected out of the professionals in the health care industry.
Many local and national organizations offer certifications to medical billing and coding professionals. However, the requirements for certification vary from one organization to the other and so are their credentials. Basic requirements to acquire certification are to complete a graduation course and have a certain amount of work experience which may vary from two years or even more.
This certification is generally valid for two to five years is given after the professionals appear and pass the examination. One can apply for re-certification but this requires continuous education in order to be eligible.
Skills and Abilities
What are the skills required to be a medical biller and coder?
A properly trained medical biller and coder form a valuable asset to a health care organization. In order to work to perform the activities efficiently and excel in the profession, these professionals need to have a basic understanding of certain medical skills which will help them in their everyday administrative activities. Thus, following are some of the skills required to be a medical biller and coder:
- Knowledge of word-processing: Medical billing and coding professionals are required to gain proficiency in typing. They must be able to type correctly without making a mistake while entering the code for the medical procedures performed as any keying errors will result in the rejection of insurance claims hence, adversely affecting the financial resources of the patient and the hospital. These professionals should be perfect with work processing skills.
- Knowledge of Medical terminology: Medical biller and coder must be able to understand and use medical terms which will help them with their billing and coding of medical services. For example, they must have the ability to determine a cardiac arrest have knowledge of what a cardiology means.
- Excellent Communication skills: Medical billing and coding professionals are often a bridge between insurance agencies and the health care organization. It is these professionals who communicate with the patients and the insurance companies for the repayment of the medical services provided and this requires them to talk to them over the phone or in person. Thus, it is important for these professionals to have excellent verbal and written communication skills. They should be able to write correctly and in a precise manner.
- Knowledge of Anatomy: Medical billers and coders are required to have a basic understanding on the human body such as the reproductive and the cardiovascular system as this knowledge will enable them to comprehend and read a doctor’s report thus, knowing the appropriate procedures to assign codes for the purpose of insurance claim.
- Attention to Detail.
- Excellent Mathematic skills.
- Knowledge of procedural coding.
- Organizational Skills.
- Ability to coordinate with various other medical professionals.
What is the career outlook of a medical billing and coding profession?
A certified medical billing and coding profession would have a number of employment opportunities as many large health care organizations such as hospitals, nursing homes and other medical facility would prefer to hire a certified medical biller and coder. Within no time, this professional can expect advancement and promotions in his job and can train other professionals too.
Individuals, who are looking for job in the administrative field of medicine, can opt for this position as it is one of the fasted growing careers in the health care industry. The employment rate for medical billing and coding professionals is very bright as the profession is facing an acute shortage of qualified and skilled medical billing and coding jobs and there are plenty unfilled positions in the industry.