how to become a medical biller

Healthcare worker with stethoscope typing on laptop

Looking to make a career change? Making the decision to work in healthcare is a smart move. Healthcare offers you the opportunity to make a real difference in people's lives, have a stable, reliable job, and grow and advance in an in-demand field.

While there are many healthcare careers out there, medical billing and coding is unique in that you have the potential to complete your schooling and start working in less than a year. Not to mention, it often offers a flexible work environment with the ability to work from home or own your own business!

Ready to learn more? We put together this guide to provide you with the answers you need about a career in medical billing and coding.

Part One What Is Medical Billing and Coding?

You visit a physician's office or a hospital to see the doctors, nurses, and therapists who provide health care.

But there's another group of people behind the scenes who you don't see. These people do the administrative work, including medical coding and health insurance billing.

Medical billing and coding professionals (CPCs) translate your healthcare provider's diagnosis and treatment into standardized codes that get sent to insurance companies and government agencies.

The healthcare industry uses a coding system to be sure the treatments and procedures you received match insurance billing and government standards.

Coders and medical billers -- known collectively as medical records and health information technicians -- maintain the healthcare revenue cycle. They help ensure healthcare providers get reimbursed by insurance companies quickly and efficiently.

To do their jobs, billers and coders need to understand how the medical insurance system works. They also must know how to code the information correctly to expedite claims, and what to do if a claim is denied.

Their specialized knowledge, skills, and efficient job performance make medical coding professionals valued members of every healthcare team.

Part Two What Does a Medical Coder Do?

Medical coding is the first step in recording patient data, both for patients' medical records and for billing purposes.

Medical coders use intricate classification systems to translate medical information into codes which can be entered into billing systems and patient medical records.

These classification systems are ICD-10-CM, HCPCS Level II and CPT which we'll discuss more below. This process allows everybody who touches a patient's records to have a universal understanding of the patient's diagnosis, as well as the tests and procedures that were ordered and delivered.

It is a medical coder's job to make sure the correct code is identified and recorded.

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Part Three What Does a Medical Biller Do?

Once a healthcare professional has provided services to a patient, a bill needs to be submitted for payment. These bills get sent to insurance companies and government agencies as well as to patients. Bills must be accurate to facilitate quick payment. Here are some of the duties a medical biller may perform:

A medical biller reads and reviews medical records -- which may or may not have been coded -- and translates them into a bill.
Medical billers then have to keep track of the bill to make sure it gets paid.
To ensure accuracy and quick reimbursement, medical billers may need to gather patient and insurance information before the patient sees a doctor or nurse.
Getting patient information first can expedite the insurance claims process by making sure the patient has health insurance coverage. If needed, the medical biller can get preauthorizations, collect patient payments, and check all billing for accuracy before submitting it.
Medical billers also record payments as they are received.

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Part Four Medical Billing and Coding Salaries

Medical billers and coding professionals both have unique skill sets and responsibilities, but medical billers and coders earn roughly the same amount and are both classified as medical records and health information technicians and earn a median annual wage of $42,630 as of 2019 according to the BLS.

According to the annual salary survey conducted by the AAPC (American Academy of Professional Coders), the average medical coding salary is $53,396, with certified coders earning 33% more than non-certified coders.

The Bureau of Labor Statistics estimates this profession will add 29,000 more positions by 2029.

How to Earn More Money as a Medical Coder or Biller

Medical coders and billers can earn more money by earning certifications:

Coders with one certification earn an average of $55,923 per year
Those with two certifications earn an average of $64,890 per year
Those with three or more credentials earn an average of $70,608 per year

Along with these average earnings, billing and coding jobs tend to come with benefits including health insurance, disability insurance, vacation and sick leave, and retirement plans.

Some employers offer childcare reimbursement, tuition reimbursement, and other perks.

Part Five How to Start Working in Medical Coding and Billing

One of the most appealing aspects of medical coding and billing is the fact that it's possible to earn your certification or diploma in less than one year.

If you choose this career path, you have the option to earn a certificate, diploma or associate degree in medical billing and coding. You'll then take special classes on the job's important responsibilities.

Coding courses and certification exams -- not research papers and diplomas -- help determine whether you're ready to enter the workforce as an entry-level medical biller or coding professional.

What You'll Learn in a Medical Coding and Billing Program

Both medical billing and medical coding certifications require that students learn federal coding standards in:

CPT (Current Procedure Terminology standardized by the American Medical Association)
ICD 10-CM (Coding standards for diseases and disorders issued by the Centers for Medicare and Medicaid Services)
HCPS (Coding standards for medical services and supplies issued by the Centers for Medicare and Medicaid Services),

Because of the similarities between the two careers, some programs combine billing and coding into a single curriculum that provides dual certification. If you prefer to pursue just one path, there are differences between the two curricula.

Medical Billing Program Curriculum

The Medical Billing curriculum will include coursework in:

Medical Terminology
Medical Insurance Principles
Medical Reception
Medical Billing Technology

Medical Billing Certifications

These courses prepare you for taking tests to provide the following credentials:

Certified Professional Biller (CBP) issued by the American Academy of Professional Coders
Certified Medical Reimbursement Specialist (CMRS) issued by the American Medical Billing Certification
Certified Medical Billing Specialist (CMBS) issued by the Medical Association of Billers

Medical Coding Program Courses

Medical Coding curriculum will include coursework in:

Anatomy
Pharmacology
Medical Office Procedures
Medical Records

Medical Coding Certifications

These courses prepare you for taking tests to provide the following credentials:

Certified Professional Coder issued by the American Academy of Professional Coders
Certified Coding Associate (CCA) issued by the American Health Information Management Association
Certified Coding Specialist (CCS) issued by the American Health Information Management Association
Certified Coding Specialist: Physician-based issued by the American Health Information Management Association

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Part Six Medical Coding and Billing Certification Programs

Medical coding and billing certification programs are available online or in person. Enrollment in either type of program offers its own advantages and disadvantages.

In-Person Programs

While learning in a traditional classroom setting gives students face time with an instructor and other students along with hands-on training, it also requires that you adhere to the institution's schedule.

This may limit access for students who do not have a program nearby, or who are pursuing their education while also working at another job or attending to family responsibilities.

Online Programs

By contrast, online medical billing and coding training programs offer scheduling flexibility allowing you to study when you are available as long as you complete your coursework. You can access programs anywhere without leaving your home, and these programs are often less costly.

But you give up access to face-to-face support from teachers and the comradery of interacting with fellow students, and you need access to technology and an internet connection.

Part Seven Where Do Medical Coders and Billers Work?

Working as a medical records and health information technician -- whether in billing, coding, or both -- can provide both stability and flexibility. Though, it's important to note that some people do report having a difficult time finding their first job in the medical billing and coding profession, as many employers are looking for candidates with at least 3 years of experience.

Though you can work a typical 40-hour week in any type of medical facility, you may also be able to work as a freelancer in the comfort of your own home.

Typical work environments for medical coders and billers include:

Doctors' offices
Clinics
Hospitals
Outpatient surgery centers
Nursing homes

Medical coders and billers can also work in less traditional settings. Many work for insurance companies, where they verify incoming insurance claims. Some work for law firms, interpreting medical records as part of insurance fraud investigations or within the scope of personal injury litigation.

Others work for government agencies, collating information that is used for setting national or local healthcare policy.

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Part Eight Medical Coding and Billing Jobs: Employment Rate by State and City

When considering a new career, one of the most important factors to be weighed is whether you're likely to be able to get a job where you live, or where you want to live.

As of May 2019, the BLS indicated that there are 215,500 medical records specialists and health information technicians working in the United States, and the five states with the highest level of employment of these professionals are:

California
Texas
Florida
Ohio
New York

The metropolitan areas with the highest levels of employment for these professions are:

Los Angeles/Long Beach/Anaheim, California
New York/Newark/Jersey City New York/New Jersey
Chicago/Naperville/Elgin Illinois/Indiana/Wisconsin
Dallas/Fort Worth/Arlington Texas
Houston/The Woodlands/Sugarland Texas

The five states paying the highest annual mean wage for medical billers and coders are:

District of Columbia
Alaska
Hawaii
Massachusetts
Washington

Part Nine Where Can I Learn More About Medical Billing and Coding

As you can see, there are many reasons to choose a career path in medical billing and coding. A small time investment can generate significant rewards, job security and opportunities for growth and advancement.

For more specific information, the best resources are the professional organizations dedicated to advancing the profession. These are:

The American Association of Professional Coders (AAPC)
The American Health Information Management Association (AHIMA)
The Medical Association of Billers (MAB)

Part Ten Why Should You Start a Career in Medical Coding and Billing?

Competitive pay, flexible hours, low barriers to entry -- you can see why people want to become medical records and health information technicians.

Here are some other benefits we haven't discussed yet:

Medical billers and coders are valued and respected members of the healthcare team.
Their work keeps revenue flowing into the organization and allows clinical staff to concentrate on providing patients with attentive care.
The job offers tremendous flexibility in terms of work environment, including the ability to work from home as an online medical billing or coding professional.
As the population continues to age there are more and more people in need of healthcare, and many of those already working in the field are beginning to retire, so there are plenty of opportunities and job stability.
Healthcare facilities are everywhere, so no matter where you want to live or what type of setting you want to work in, you are likely to find employers eager to hire someone with your skills.
Once you're in the field you'll find plenty of room to grow, either by moving into management or transitioning into a hands-on caring position like nursing.
Perhaps most importantly of all, medical coders and billers perform work that can make a real difference in patient health and outcomes.

Though they don't provide hands-on care, the information these professionals code and record becomes a vital part of the patient's medical history. Physicians and other medical professionals rely on this information to maintain a reliable revenue cycle.

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Part Eleven Medical Coding and Billing FAQs

How long do you have to go to school to be a medical coder or biller?
- Depending upon whether you choose to pursue an in-person program or an online program, becoming certified as a medical biller or coder can take as little as four months or as long as fifteen months. There are a variety of advanced certifications that can be pursued that will take additional time, but basic entry into the field generally takes less than a year.
Is medical billing and coding hard?
- As is true of any skill, medical billing and coding is only difficult before you learn how to do it. Coders and billers are taught the process of using reference books, software, and the basics of anatomy, physiology, and medical terminology so that they can confidently apply that information to their jobs.
What does a medical coder do all day?
- Medical coders and billers generally work in office settings. They begin their day by checking their email and voicemail messages, then log into their employer's database system before beginning to process the patient charts that accumulate throughout the day as patients are seen by the clinical staff. Each chart is examined with the intent of labeling and assigning the correct diagnostic and procedure codes for submission to insurance companies, Medicaid or Medicare, workers' compensation, or other payers.
How much does medical coding and billing pay?
- The average annual salary for medical coders and billers is $54,401 with an annual growth rate of 9 percent.
How much does medical coding and billing school cost?
- Tuition for a few online medical billing and coding programs cost less than $1,000 but most programs range between $1,000 and $2,500 to become certified. Some community colleges offer associate degree programs. These tend to cost more.
What are the prerequisites to attend a medical billing and coding program?
- Most programs require earning a high school degree before enrollment.

Resources

For additional Medical Billing and Coding information, check out:

This is Why Starting a Medical Billing and Coding Business Was the Best Decision for Me
Medical Coding and Billing Careers Guide 2021
Top Medical Billing and Coding Schools 2021
What is Medical Billing and Coding? Codes & Fundamentals