As big as the health care industry is, it needs medical billing and coding clerks to process payments from insurance providers and patients. These clerks work with patients, insurance providers, individuals in other medical careers and others to make sure payment is received for services rendered.
About one-third of all billing clerks are employed in the Health care industry, where medical coding is an integral part of the billing process. Training for jobs in medical billing and coding includes coursework that explains how universal codes are used to indicate whether the service occurred in a doctor's office, an outpatient facility or the emergency room. Another set of codes will indicate the doctor's diagnosis and what medication, if any, was prescribed. Additional codes are used to indicate the type of insurance a patient has and how much the patient is required to pay out-of-pocket.
Most patient records are maintained electronically today, which has made the accounts payable department in hospitals and doctor's offices more efficient. Health care professionals such as doctors, registered nurses and radiology technicians enter the appropriate codes into a database at the time of a patient's visit. Individuals in medical billing and coding jobs then take the information and bill the appropriate parties. They check with a patient's insurance provider to make sure it will cover procedures or services rendered and at what percentage of the total cost.
Medical billing and coding professionals need to be familiar with health care databases, which are designed to accommodate the medical coding system. Because they work with patient records which are protected under HIPAA laws, certain precautions must be taken to maintain confidentiality. Individuals in this profession work closely with informatics specialists – information technology professionals who work with health care records – regarding database security matters.
The starting salary of medical billing and coding jobs averages $22,860 annually, and the salary of individuals in this profession peaks at $51,510 annually. You will likely work full-time for a hospital or doctor's office, where you will be eligible for medical insurance and other benefits.
Presently, 172,500 individuals are employed as medical billing and coding professionals. Over the next 10 years, the profession is expected to grow by 20 percent as a result of the increased health care needs of the aging baby boomer generation.
An associate degree in medical billing and coding is generally required for this profession. In addition, you should receive the Registered Health Information Technicians credential, which is offered by the American Health Information Management Association to individuals who pass a written examination and who also meet the education requirements.
The Board of Medical Specialty Coding and the Professional Association of Health care Coding Specialists also offer credentialing in medical coding. The National Cancer Registrars Association offers the Certified Tumor Registrar credential, and other credentials in specialized fields are also available. Most medical billing and coding clerks are hired at entry level and complete certifications as part of their continuing education.
More efficient versions of health care databases are expected to automate some health care billing processes in the near future. To ensure advancement opportunities, learn as much as you can about technology and computer software.
Medical billing and coding clerks usually work full-time for a hospital or a doctor's office, although part-time positions are available. If you work for a smaller facility, you may double as a receptionist. You will work directly with patients, often checking with patients' insurance providers at the time of their visits or beforehand to make sure procedures are covered.
In larger facilities you will not necessarily interact with patients at the time of their visits; however, you will often communicate with patients over the phone after visits to arrange payment plans, if necessary. Since many patients don't have insurance, they must pay out-of-pocket for such things as medical emergencies, which can be costly.
Most hospitals have programs which provide aid to patients who cannot afford to pay their health care bills. However, patients who do not qualify for such programs must provide payment. Those who do not pay in a reasonable timeframe and who do not make an effort to communicate with your facility regarding payment are often sent to collections. Although a certain amount of sympathy is in order for patients, they must realize that hospitals and doctor's offices are businesses just like any other entity that provides products and services.
Expect to work day shifts, although in larger facilities, individuals in this profession may work some evening hours to accommodate patients' schedules.
In this position, you will likely sit at a desk for long periods of time. Make sure to take frequent breaks and to get adequate exercise to prevent injuries which can develop over time, such as back problems and carpal tunnel syndrome. Because you will work in front of a computer monitor, you need to be able to see detail at close range. If you interact with patients, you will likely wear a uniform such as scrubs.
Basic Office Skills Required
Basic spelling, grammar and punctuation skills, as well as typing, data entry, 10-key and basic math skills are necessary in this profession. Have a working knowledge of common office software such as MS Word, Excel and Outlook. This job requires communicating with insurance providers and others over the phone, so good verbal communication skills are as well. Bilingual speaking skills are also helpful and encouraged. Be able to plan ahead and meet deadlines.
Medical billing and coding clerks make sure procedures and other services rendered at hospitals or other health care facilities are paid for by patients and their insurance providers. Medical jobs such as this are becoming increasingly technical as patient records are maintained more than ever in special databases designed for medical coding.
Julie works as a receptionist at a medical clinic that houses three family doctors and a physician's assistant. She handles all the medical billing and coding needs of the office, which requires her to coordinate with patients, insurance providers and individuals in medical careers to bill the appropriate parties accurately and efficiently.
Julie has training in medical coding, a standard method of identifying procedures, diagnoses, and the types of visits on patient charts. When new legislation was passed that required doctor's offices and hospitals to maintain their patient records electronically, Julie worked with one of the doctors to select a medical database system that would work best for their office. She welcomed the excuse to computerize everything because it made getting information about patient visits from her colleagues easier. Now she can just email the medical assistants and ask them to fill in the medical coding fields in the database that they are responsible for filling. The doctors in her clinic have established tasks associated with medical billing and coding as a priority, for it is only when Julie has all the information that she can bill patients and their insurance companies.
Certain procedures that the clinic does on a regular basis are often not covered by insurance providers, and she knows the ins and outs of the major insurance providers that she frequently works with in her medical billing and coding. If in doubt, she will call a patient's insurance provider before or at the time of the visit to make sure a procedure is covered. This is a courtesy to their patients, but it also improves the clinic's chance of receiving payment for the services provided. The clinic works with patients who don't have insurance as long as they make regular payments. If they don't, she is forced to send them to collections, which she always does as a last resort.
In association with medical billing and coding, Julie manages all the HIPAA requirements for the clinic. She makes sure all the clinic's active patients sign the HIPAA information and disclosure form each year. She also manages any requests for patient charts, as there is a special procedure they need to follow – both for providing charts of their patients to other doctors, as well as receiving patient charts from other doctors.
Julie received her associate's degree as a health care administrator years ago, but she has maintained her certification, which involves passing a test. Every so often, the doctors pay for training courses for her to attend. She took a computer course, for example, when they got their new medical database system installed, and once she was trained, she was able to show all her colleagues how to use the software, as well.
Medical billing and coding, like any accounts payable system, is a critical part of the clinic where she works, since that is how they receive the funds that fill the payroll and pay the other bills. She knows individuals in other medical jobs with whom she works depend on her persistence and accuracy. The clinic's patients also depend on her, when possible, to make sure the procedures the doctors perform are covered by insurance.
Medical billing and coding jobs favor individuals with strong computer skills.
Jobs offer only an average salary, although you will be eligible for insurance.
Choose medical careers like this if you are computer savvy and want a stable job.