Be Informed! Understanding the Role of the Medical Billing and Coding Professional

The role of a billing and coding professional as part of the larger healthcare delivery system is vital to the success of any practice, clinic, or hospital. Billing and coding specialists are responsible for the process of assigning codes to medical procedures and then submitting claims to insurance companies and patients for services rendered. The process of assigning codes, billing, and ensuring payment is received is essential to the success of all healthcare providers. Without a steady, and accurate, revenue cycle the provider will lack the resources to provide high quality and patient-centered care.

Medical coding and billing professionals are not required by law to become certified but are encouraged to pursue certification. The certification process requires billing and coding specialists prove a theoretical and practical understanding of the billing and coding process. It also provides evidence to employers that the individual is committed to the vital role of billing and coding by careful preparation and practical application.

A career in medical billing and coding may be right for you if you:

• Like working as part of a larger medical team A billing and coding specialist works alongside other healthcare professionals to provide high quality patient care, maintain the provider’s revenue cycle, and operate an efficient practice, clinic, or hospital.
• Want a job that is constantly changing and evolving The medical coding and billing field is currently preparing for the implementation of ICD-10, a new coding system that must be fully in place by October 1, 2014. The shift to ICD-10 requires professionals to be educated and trained on the new system and the significant changes from the previous coding model. This is just one way that the profession is evolving. As healthcare delivery changes, so does the work of the professional in billing and coding.
• Desire flexibility in your job A career in billing and coding allows professionals to choose between multiple work settings and flexible working conditions. Billers and coders may choose to work for a small practice, a larger healthcare delivery system, or for an independent hospital. There is also flexibility in working conditions involving hours and location. Some billing and coding professionals work from home and set their own hours around their family’s needs.
• Are organized and motivated Since healthcare providers depend on the work of the billing and coding specialist to maintain a revenue cycle it is crucial that professionals are analytical, organized, and motivated. Successful billing and coding specialists are efficient and motivated to process codes and claims quickly and accurately.

The general career description of medical billing and coding is actually two separate jobs that require different skills and impact the healthcare system in distinct ways.

Medical Coding The medical coder analyzes and interprets the patient’s interaction with the entire healthcare team including physicians, nurses, surgeons, therapists, laboratories, and diagnostic professionals. The coder must also determine the nature of the visit, the procedures completed, and the details of the care provided. Then the correct procedure and diagnosis codes are applied to the patient’s record to reflect the services that were provided.

The accuracy of the billing process requires the medical coder be thorough and careful in assigning codes. Coders must often contact physicians about specifics of a patient’s care. This allows the coder to have a better understanding of the patient’s encounter and the nature of the services provided.

Medical Billing The medical biller converts the work of the coder to a concise and accurate bill then submits it for services rendered. Electronic software is used to create a bill that is then submitted to the payer, either an insurance company or the patient, to be paid. Once an insurance company has submitted its portion of the payment the remaining balance is billed to the patient for most claims.

Medical billers are on the front lines with both insurance companies and patients and must possess exceptional communication skills. They must be able to interpret and explain the billing process and answer questions about procedures and how charges were assigned.

What do you think are the most important skills for a successful career in billing and coding? Which specialty do you think is the better match for your skills?