A medical billing and coding specialist records and processes patient health records in a medical practice, hospital, or insurance company. This person is primarily responsible for organizing patient files and making sure that notes about exams and treatment regimens are accurate and accessible. He or she may also process payments, including sending out bills and dealing with insurance claims. The job only rarely requires direct patient interaction, but specialists are sometimes called on to explain or interpret records if there is confusion about what is being billed or what sort of services were rendered.
The bulk of most medical billing and coding specialist work involves transcription. When doctors, nurses, and other medical professionals meet with patients, they often take notes by hand or on portable electronic devices. These notes are often an important part of patient care, but are not always streamlined — they may be written in shorthand, for instance, or scribbled in the margins of a patient’s main file. Billing and coding specialists will organize all of these notes into a unified file that can be easily searched and cross-referenced at a later date.
Listening to orally recorded notes may also be part of the job. Many medical professionals dictate their impressions of patient conditions or thoughts on treatment that must then be integrated into patient files. Billing and coding specialists are often in charge of reviewing these recordings, transcribing them, and then determining how to best build them into the permanent record.
Building up a patient file is important but is usually only a preliminary step. The next thing that a medical coding and billing specialist must do is to assign each treatment decision a “code,” usually a letter or number-based sequence, that signifies both what the treatment was for and how it is going to be billed. A physician’s time is typically billed hourly, for instance, which gets one code. Things like urine processing, blood screens, and injections are also coded, as are more major procedures like X-rays, ultrasounds, and specialist referrals.
Most of the time, codes are streamlined on a country-by-country or region-by-region basis. Some of this is dictated by insurance plans, but a lot of it is driven by governments. Having a unified medical coding system helps improve the efficiency of medical care while reducing fraud. Billing and coding specialists must be careful to keep their records very accurate, and as a result, they may spend about as much time reviewing their work as they do creating it in the first place.
Importance of Analysis
Specialists usually keep coding manuals and software “cheat sheets” handy as a reference, but the job is usually about much more than simply plugging numbers in for different conditions. The best specialists are able to synthesize notes and lab results into more comprehensive diagnostic information, an exercise that often requires a lot of analysis and at least a basic knowledge of how the medical system works. Some of this can be learned on the job, but an equal amount depends on specialized training and a keen eye for detail.
Emphasis on Electronic Record Keeping
Many parts of the world use a system of electronic medical records, known as EMRs for short. EMRs are a streamlined way to digitize and maintain huge amounts of patient information and diagnostic material in electronic format in a way that both saves physical space and makes records more universally accessible. While EMRs are very efficient for most medical practitioners, they often add an extra step for coders and billers. Specialists must be trained in not only electronic databasing but also any applicable privacy and patient access laws. Errors in security or entry can make electronic files vulnerable, which is a big problem for coders, practitioners, and patients alike.
Most of a specialist’s work is done “behind the scenes,” with files coming in from medical offices and insurance companies without much personal interaction. Still, there are some situations in which specialists are called on to deal directly with patients. This is most common when there is some sort of dispute — when a patient insists that he did not receive a certain coded treatment, for instance, or when an insurance company denies coverage for something coded as a routine procedure. In these sorts of cases, specialists may work directly with patients to get to the bottom of the problem and, at the very least, will reach out to the medical professionals involved to get some clarity on the situation.
Specialists sometimes also act as liaisons between medical practices and insurance billing agents. Information about claims, issues with payments, and questions about particular coverage policies are often within the realm of a specialist’s expertise.
Importance of Teamwork
A lot of the work that coding and billing specialists do is somewhat solitary, but teamwork is nevertheless a central part of the work in most places. Coders and billers must work together to produce comprehensive records, and they are often responsible for checking each other’s work. In most cases, each professional only has one piece of a larger record or file. It is only when all efforts are combined that a coherent and useable coding system comes into being.
Different Job Settings
Most coding and billing specialists work directly with medical professionals, but not all do. They are frequently hired by hospitals, home care clinics, and outpatient service centers — basically anywhere where patients receive treatments or diagnosis information. Specialists are commonly on staff with insurance companies, too, in order to help process claims and interpret incoming files. Many local and national governments also hire people with this sort of experience, particularly in places where there is a national healthcare plan or government-run medical records systems.
A number of specialists may also work from home-based offices. This is most common after a specialist has gotten a few years’ experience in an office setting and has proved him or herself, but can sometimes be an option for people just starting out, too. Particularly in practices where most files are shared and stored electronically, there is often no reason why coders and billers cannot work remotely. They may be required to attend certain meetings and trainings on-site, but the bulk of the work can generally be done from almost anywhere.
A person must typically have at least a high school diploma in order to become a medical billing and coding specialist, though many employers want people who have obtained an associate or bachelor's degree. Most medical billing and coding specialists receive on-the-job training to learn about the different aspects of the work, but this is rarely a replacement for substantive background knowledge. Candidates who have taken even just a few courses in anatomy, medical procedures, or diagnostic specialties are usually given preference. These and similar courses are often taken as part of a coding certificate course.
Certificates are usually granted by national organizations, such as the American Medical Billing Association in the United States. Students typically enroll in order to improve their credentials and show potential employers that they are serious about their work. Certification tests can be taken at many community colleges and universities, and may also be available online.