The Billing & Coding Specialists ensure that the health care system continues to run smoothly and efficiently. They act as a connecting link between the health care practitioners, administrators, insurance companies, and legislators. Billing and coding specialists are not directly involved in health care and do not perform any clinical duties; but they are crucial to overall administrative and business functioning of health care system.
The billing and coding specialist provides proper coding on the patient’s entire treatment process. Some important areas include medical history, medical diagnosis, tests undertaken and treatment prescribed; follow ups and results, modifications in treatment etc. These details are carefully and correctly entered into the prescribed system, and the information is private, secure, and legally protected. All coded medical records are used for billing and the same are shared with the patient as well as the insurance company, wherever applicable.
Medical billing and coding specialists have a range of various types of employers, all of whom are primarily involved with the health care billing process.
The most obvious employers are health care institutions and medical facilities such as hospitals, clinics and private medical practices.
Other employers for medical billing and coding specialists are
- Insurance companies
- Ambulatory care centers
- Medical equipment suppliers
- Health care consulting firms
- Public health agencies
- Medical billing companies
Apart from full-time employment, part time and contractual work-from-home opportunities may also be available for billing and coding specialists.
Training can be of two types (1) On the job and (2) Professional classroom training.
On-the-job training used to be popular in the past. But with growing demand and increased complexity of the profession, along with the legal ramifications in case of mistake or discrepancy, employers are increasingly looking for pre-trained employees.
Prior to gaining employment, an employer will interview / test the candidate on his proficiency of the prevalent billing and coding standards. The candidate must gain mastery of the same in order to gain meaningful employment and good remuneration.
Some candidates might go for Certified Medical Reimbursement Specialist (CMRS), Certified Billing & Coding Specialist (CBCS), and Certified Professional Coder (CPC) certifications. These certifications are not compulsory. Experience and knowledge are the basic requirements for gaining employment and career growth as a medical billing and coding specialist. A good training program usually prepares you to sit for these exams and be able to clear them.
Skills to Be Learnt
A good training program is designed to impart requisite knowledge about billing and coding basics, medical terminology, HIPAA privacy laws, and regulations & control.
Some important skills acquired during training that are required to perform duties as a billing and coding specialist include:
- Remaining in purview of legal concepts, such as, living will, power of attorney, advance directive and guardianship
- Understanding and being able to explain the HIPAA privacy rule
- The methods and rules for protecting and disclosing Protected Health Information (PHI)
- Knowing about health insurance requirements
- Understanding how health insurance fraud occurs and how to prevent fraud and abuse
- Accurately understanding the codes from ICD-9-M, CPT, HCPCS Level II Coding Manuals
- Assigning codes from ICD-10-CM Official Draft Code Set
- Doing the documentation for an insurance claim
- Using the EDI (Electronic Data Interchange)
- Knowing about manual and computer aided coding
- Generating manual and computer aided billing
- Having required knowledge of human anatomy, physiology, medical terminology, diseases, treatment processes, pharmacology etc. for being able to accurately maintain, code and process documentation
- Ingrain ethical and moral responsibilities, and understand legal responsibilities of the role
- Having good communication skills and people handling skills, ability to work alone as well as in a team