Medical billing and coding professionals work i n one of the fastest growing occupations in the United States, with a projected increase in employment of 22%. In fact, with the constantly rising need for healthcare services, the field is set to grow even further. 

Billing and coding professionals, also called technicians, play a key role in healthcare services. There is a reason why they are known as the backbone of the revenue cycle of the industry. Entry-level professionals employed in the top-grade medical billing companies in Texas earn $40,135 on average when last surveyed in August 2022. 

After witnessing such big salary figures, it will be no shock if you opt for this career path. In this guide, we have detailed what a medical coding and billing specialist is and what job they perform. 

If we say in layman's terms, medical coding and billing professionals act as middle people for insurance companies and healthcare offices. How so? A coding and billing professional assists healthcare systems in managing insurance claims, payments and invoices. Their job description includes:

● Assign codes to each healthcare procedure

● Using those codes for billing

● Make payment arrangements

● Collecting and monitoring accounts

● Dealing with claim denials

● Following up with insurance companies and patients about outstanding balances.

Even though these medical professionals work in the same facility where patients visit to receive healthcare services, their job is entirely different from that of patient-facing ones. They spend most of their time on computers in front of screens to enter, review, and update data in a timely manner. 

Medical coder and biller are two different domains and have unique job descriptions. However, they both go hand-in-hand. If the coder doesn’t do their job correctly, the biller will have to suffer. Let’s take a deeper look at both the jobs individually. 

A medical coding professional converts diagnostics and procedural notes into the right codes for billing and record tracking. What are those codes? They are standard alphanumeric combinations that help figure out services being provided at a healthcare facility to the patients. Here is an example of how these codes are used:

● Current Procedural Terminology(CPT): It is a medical code used to recognize medical procedures and diagnostics services provided to a patient. 

● International Classification of Diseases(ICD-10): It is another code used by healthcare systems for medical diagnosis. The CDC’s official website writes that the ICD-10 code is 

● Healthcare Common Procedure Coding System(HCPCS): It is a collection of medical codes that illustrate products, supplies, procedures and services which possibly be provided to patients covered under the Medicare program as well as those with private healthcare insurance.

Healthcare systems use these codes under specific guidelines to prepare insurance bills using the billing software. 

The coders may enter the codes as soon as a care receiver books an appointment based on the type of visit and the health condition reported by the patient. More codes will be applied once the medical staff checks the patient and observe their symptoms after diagnosis.

What is the job of a medical biller?

Once the coding is completed, then starts the job of a billing professional. Using those codes, the individual will prepare invoices and send them to the insurance providers of the care receivers. The insurance company then cross-check if they cover the received services and then provides reimbursements accordingly. The remaining balance is then sent to the patients for payment. 

The billing process may start as soon as the patient books an appointment with the healthcare provider as codes have to be submitted to the insurance providers for pre-approval. Doing so helps some patients determine how much will be their out-of-pocket expenses.

Is it important for medical billers to understand industry codes?

As with billing processes, a professional must have a sound understanding of industry codes as they have to deal with disputes and deny insurance claims. Also, they might need to update some codes prior to resubmitting them. And sometimes, they must cross-check the codes if they are rightly assigned and incorporated before submitting them in the first place. 

Once the insurance claim has been accepted, the patients will be sent an invoice for the outstanding balance. It is the job of a billing specialist to check no bill goes unpaid, and if it does, they will contact the insurance company to ensure all the paperwork and documentation is in order. 

When a patient fails to pay an outstanding balance within a specified period and disregards further requests, the billing specialist will hand over the matter to a collection agency. 

To become a certified medical billing and coding specialist, an individual must obtain relevant training and certification. Several colleges in the US offer an array of courses, diplomas and certifications specific to this field. However, you need to check for pre-requisite before taking up this career, as some colleges and universities require you to have at least a high school diploma or GED or equivalent education. Some programs may require prerequisites in courses like anatomy and physiology. Therefore, it is recommended that you must decide in which domain you want to go and then look for institutions that offer certification in that particular field. 

Conclusion:

Indeed, medical coding and billing are one of the high-paying jobs across the United States. In fact, some medical billing companies in Texas pay their employees around $27.31 hourly wage making it $56,803 per year. If you are detail-oriented and good at time management, we would suggest you go for this career path. Also, ensure you are comfortable spending long hours in front of the screen as most of your work will be on a computer. Workers in this field must also keep themselves updated with the changing trends, procedures and coding guidelines.