Medical billers and coders may be called by other job titles by some employers and by other entities.
The Bureau of Labor Statistics (BLS) includes them in its category of medical records specialists.
Anyone who wants to work as a medical biller or coder in the U.S. can have good career opportunities.
The BLS indicates that job growth will be much faster than average when compared to all other occupations, through at least 2034.
So, what are medical billing and coding specialists?
The two job titles are often used together, by many sources, including schools, in the media, and by employers.
Yet, there are some differences between the two jobs.
Medical billers and coders both have important roles in the healthcare industry.
They both work with the medical records and files of patients.
The work that they do helps to reduce errors and fraud.
The work that medical billers and coders do also helps to make sure that healthcare providers receive the proper payment and reimbursement for their care and services provided to patients.
Medical coders use universal codes from classification systems to describe or convert patients’ diagnoses, treatments, and procedures.
The codes are then used as a means of communicating with insurance providers, various government agencies, and certain other entities.
Medical billers create bills, commonly referred to as claims.
They submit the coded information in the claims to insurance companies, and sometimes to other providers, to receive payment for services rendered.
Medical billers also monitor submitted claims to make sure that the healthcare providers receive timely payment.
People who want to work in the medical billing and coding industry need to know the license requirements for their state.
If they plan to work in a different state than the one where they live, then they must comply with the laws and regulations of the state where they plan to work.
The same is true for states that require medical billers and coders to have and maintain a certification.
Some states may have employer-based standards. Medical billers and coders must abide by those standards to get or keep their jobs.
States That Require Medical Billers and Coders to Have a License
None of the states in the U.S. requires medical billers or coders to have a license.
That said, there are strict requirements to work in the medical billing and coding industry.
Each state has its own requirements.
It is important for people who want to work as medical billers or coders to know the state requirements.
Some people may want to work in a different state than where they live now.
They should look at the state requirements for where they want to work, not the state where they live right now.
It is also important to know that the licensure requirements for medical billing and coding specialists may change in the future.
Some states, or all states, may require medical billers and coders to have a license.
It is the responsibility of future and current medical billing and coding specialists to stay informed about license requirements and other requirements to work in the field.
Students and others who want to work in the medical billing and coding industry need to comply with the educational, certification, and employer requirements to get the best jobs in this growing field.
States That Do Not Require Licensure but Mandate Certification or Training
The best job opportunities for medical billing and coding specialists will likely go to people who complete an education or training program.
There are age requirements and the possibility of other requirements that employers set for their medical billers and coders.
One of the most important things that people who want to work as medical coding and billing specialists should have is a certification.
Some people who work in the field have more than one certification.
How do students or other future medical billers and coders know which certification they need to start working in or to advance their career opportunities?
The answer is an easy one.
None of the states in the U.S. requires a specific certification for people who work as medical billers or coders.
There are several voluntary certifications that future medical billing and coding specialists consider earning before they start their career or once they get a job.
Earning one of these certifications has several benefits.
People who hold a certification are almost certainly more likely to get hired for a job, compared to those who do not have a certification.
Current medical billing and coding specialists who want to advance their careers are more likely to get chosen for supervisory jobs or similar positions.
Sources that provide salary information indicate that people who have more education, training, professional credentials, and experience earn a higher salary, compared to people who do not have these things.
Students and other people who want to become professionals in the medical billing and coding industry should consider earning at least one of these certifications. People who earn more than one certification increase their knowledge, skills, and chances of getting a good job.
Certified Professional Biller (CPB)
Medical billers who earn the Certified Professional Biller (CPB) certification know the various types of insurance plans.
They have comprehensive knowledge of the claims process, ICD-10, CPT, and other standards.
The American Association of Professional Coders (AAPC) administers the exam.
People who sit for the exam must pass it with a minimum score of 70 percent to receive this certification.
Certified Coding Associate
The Certified Coding Specialist is an ideal certification for entry-level medical coders.
People who want to sit for the exam need to have a high school diploma or a GED.
They also need to have a minimum of six months of experience coding in a healthcare setting or to have completed an approved coding program.
Certified Outpatient Coder
The American Association of Professional Coders (AAPC) offers the Certified Outpatient Coder (COC) exam.
Applicants must have two years of medical coding experience or the equivalent.
They must also have an AAPC membership and meet any other requirements.
Certified Inpatient Coder
The Certified Inpatient Coder (CIC) is an advanced certification.
The AAPC offers the exam.
Applicants for this certification need to have a comprehensive understanding of inpatient coding and reimbursement basics.
They also need to have verified experience that includes assigning medical codes for diagnoses and procedures in an inpatient setting.
Certified Coding Specialist
The American Health Information Management Association (AHIMA) offers the Certified Coding Specialist exam.
It is designed for mid-level coding and billing specialists.
Applicants who want to sit for the exam must complete an education program that includes courses in anatomy and physiology, medical terminology, pathophysiology, intermediate and advanced ICD diagnostic coding, and several other courses.
People who sit for the exam must also have at least two years of experience in medical coding.
Certified Coding Specialist – Physician-Based
The Certified Coding Specialist-Physician-Based exam consists of questions that test the applicants’ knowledge, skills, and experience.
It is a computer-based exam with up to 121 questions and scenarios.
Candidates have four hours to complete the exam.
They must have a passing score of 300 to be awarded the certification.
Applicants must have completed a medical coding program or have at least two years of experience to sit for the exam.
Certified Billing and Coding Specialist
The National Healthcare Association (NHA) offers the Certified Billing and Coding Specialist (CBCS) exam.
The exam is a good option for entry-level medical billing and coding specialists who want to earn a certification.
Applicants for this certification must have a high school diploma or equivalent.
They must also have completed a medical billing and coding education or training program within the past five years or have one year of supervised experience.
The exam has 100 questions.
It takes about three hours to complete it.
Passing the exam and earning the certification shows that people have the skills that are needed to assign codes and submit claims for reimbursement.
It also shows that people who earn this certification have the skills required for the medical coding and billing processes.
Certified Medical Reimbursement Specialist
The American Medical Billing Association (AMBA) offers the Certified Medical Reimbursement Specialist exam.
The Certifying Board of the American Medical Billing Association awards this certification.
This certification is for medical billing professionals who have comprehensive knowledge of the ICD-10, CPT, and HCPCS standards.
People who want to become medical billing and coding specialists or who want to advance their career opportunities have several other certifications to consider.
They include the Certified Risk Adjustment Coder and the Certified Professional Medical Auditor.
States with No License Requirement but Employer-Based Standards
Although none of the states require medical billers and coders to have a license or a certification, employers have their own standards.
The requirements that employers have are not primarily determined by the states.
They are usually employer-based standards.
There are some basic requirements that the states will require for people who want to work in this field.
Medical billing and coding specialists need to have a high school diploma or a GED.
They need to be at least 18 years of age.
The states and employers are likely to require medical billing and coding applicants to pass a background check.
Applicants who do not meet these basic requirements will likely not be hired for medical billing and coding jobs.
They are also unlikely to be able to sit for certification exams.
Hospitals and other healthcare facilities that hire medical billers and coders have employer-based standards.
New hires have to undergo an orientation process.
They receive training that is unique to that facility and to that department or unit.
They are likely to have to complete ongoing training so that they stay on top of new procedures, new rules and regulations, and new technologies.
One other employer-based standard that medical billers and coders usually have to comply with is that they must have a certification or earn a certification.
Once they have a certification, they may have to complete the procedures to maintain or renew their certification.
Some employers require medical billing and coding specialists to complete an education program or a training program that is related to the profession.
Employers may require that their medical billers and coders complete a certificate program.
Some other employers may require them to earn a degree.
It is important for future medical billing and coding specialists to research the employer-based standards before they apply for jobs.
Knowing the requirements of the healthcare facility or other employer can help avoid delays or rejections when looking for jobs.
Current medical billing and coding professionals who want to advance their career or who want to change jobs and work at a new facility also need to know the employer-based standards for medical billers and coders.
