What Do Medical Billers And Coders Do?

Medical billers and coders are qualified medical professionals who have gained specific knowledge in matters concerning health care. They assist medical practitioners or physicians in getting payments or claims from patients or their insurance companies. Hence, they play an important role in collecting payments, maintaining patient medical records, handling correspondence, and preparing and filing medical claims forms.

There are many types of medical billers and coders in the United States today. A majority of them work at medical facilities. However, there’s also a growing number of them working freelance.

Medical billers and coders can find employment almost anywhere in the United States. Jobs for billers and coders range from working in hospitals to working at private practice, completing projects for physicians, or performing other jobs in the medical billing and coding field. Billing software, home medical billing, online billing, and computerized billing systems are some of the career options available.

A General Overview Of What Medical Billers And Coders Do

Medical billers and coders use a variety of methods to determine diagnoses and treatments. A majority of them use computer databases to make their assessments.

They are often responsible for interpreting diagnostic reports, patient information, and research studies. Medical billers and coders sometimes work directly with physicians or doctors under the supervision of a senior physician or doctor.

They are responsible for assigning bills for services rendered and collecting payments from insurance carriers or payers. Medical coders and billers also are involved in coordinating payment with healthcare providers such as hospitals, clinics, and healthcare facilities.

Medical Billing Is Different From Medical Coding

Medical billing and coding are two different fields in the healthcare industry. Although they both belong to the information sector of the healthcare industry, they entail different sets of specialization and certification. To differentiate the two fields, it’s best to define each one.

Medical billing is the process of submitting health insurance claims on behalf of the patient to various health insurance payors for the purpose of acquiring payment for services rendered in a medical facility. (1)

Medical coding is the transformation of healthcare diagnosis, procedures, medical services, and equipment into universal medical alphanumeric codes. The diagnoses and procedure codes are taken from medical record documentation, such as transcription of physician’s notes, laboratory and radiologic results, etc. (2)

To put it bluntly, medical billers are not medical coders. So, what do medical billers and coders do?

What Do Medical Billers Do?

A job as a medical biller requires training and experience in the coding process. Although a medical biller is not a medical coder, knowledge in medical coding is crucial so that the process of insurance claims is seamless. (3)

The duties of a medical biller are as follows: (4)

  • Gathers requirements for procedures. For example, a medical biller gathers documentation such as referrals and pre-authorizations.
  • Checks benefits and eligibility verification for hospitalizations, treatments, and medical procedures.
  • Studies patient’s bills for completeness and accuracy. Then ensures completeness of data.
  • Makes use of the billing software to gather, review, and transmit claims. This includes processing claims in both paper and electronic forms.
  • Ensures unpaid claims are settled within the timeframe of the prescribed billing cycle.
  • Verifies insurance payments based on the status of the contract. Verifies contract’s discount.
  • Informs insurance companies of payment discrepancy.
  • Identifies insurances (whether they’re secondary or tertiary). Then bills them as well.
  • Reviews patient’s accounts based on insurance. This is critical especially if the patient needs follow-up.
  • Researches and appeals claims that have been denied.
  • Answers telephone inquiries of patients and insurance agencies.
  • Sets up work collection accounts and patient payment plans
  • Ensures the rate changes in the billing software are updated.
  • Updates running collection reports and cash spreadsheets.
  • Adheres strictly to the Privacy Act and HIPAA.

Many vocational schools offer programs for medical billing. Some colleges and universities also offer degrees in this area of the healthcare industry.

Training in this field may be provided by an internship program, a college internship, or a distance learning program. Those who complete a formal education and certification program are considered proficient and ready for the job market.

Before embarking on a career in this area of healthcare, it’s best to understand the description of medical billing job.

What Do Medical Coders Do?

A medical coder can specialize in one or more areas of the coding process. Most certification programs will allow students to choose from several specialty areas.

They typically take four years to complete a bachelor’s degree program. Those who want to continue their education and advance their careers can complete master’s degrees.

The duties of a medical coder are as follows: (5)

  • Reviews patients’ records.
  • Researches codes by using databases and software to ensure the right codes are used.
  • Encodes patients’ records

These are the basic duties of a medical coder. However, this does not mean that their job is a lot easier than a medical billing.

The duties of a medical coder depend on the certification. Each certification uses different codes. Familiarity of codes is critical to be a successful medical coder.

Benefits Of Working In Medical Billing And Coding Fields

There are many benefits to working in medical billing and coding. The most obvious is the opportunity to work at the forefront of medical care.

Many jobs involve helping to organize and create systems that keep track of the records of patients. Other positions may involve working with administrators in the offices of doctors. Medical billers and coders can help set up an office and train employees.

There are now many online training centers that offer medical coding certification classes. Students can complete these classes and receive a certificate of completion.

There are also vocational or technical schools that offer billing courses. Training for these jobs may be necessary, but training for the actual job does not typically have to be completed before obtaining employment.

Billing software can assist with the coding process and individuals interested in this career can make a great career decision by choosing to obtain a certification or bachelor’s degree in this field.

While medical billing job is different from medical coding job, specialists from both fields work as a team.


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