Not all healthcare heroes use stethoscopes. Some work behind the scenes, quietly managing the billing process so doctors and nurses can manage patients. If you have an aptitude for science and a passion for numbers, medical coding is fascinating work. Let’s take a closer look at what coders do and how you can land your first job in the field.
What Does a Medical Coder Do?
Medical coders, also called billing and coding specialists, manage insurance claims and other financial responsibilities in a healthcare setting, including:
Coding Insurance Forms
Most medical bills in the US are paid for by private or government insurers. Enormous volumes of data changes hands between healthcare providers and insurance companies to ensure that patients and doctors are properly reimbursed.
Medical coders streamline claim forms by translating the information in patients’ charts into short, alphanumeric sequences that describe everything from diagnostics to disorders plus procedures, equipment, and supplies. Coding makes the claims process much more efficient.
Requesting Insurance Preapprovals
Every health insurance policy is different. Billing and coding specialists work directly with companies to explore coverage for services before they’re scheduled. When services are approved, patients and doctors know they’re covered. Nothing is worse than a surprise bill.
Troubleshooting Denied Claims
Some insurance claims are denied because of insufficient information or coding mistakes. As a billing and coding specialist, you’ll investigate rejected claims, correct errors, and resubmit forms as quickly as possible for prompt reimbursement. Healthcare facilities depend on these payments to keep the lights on.
Medical reimbursement is complex. The same bill may be adjusted several times as the patient and one or more insurers pay their portions. Each payment impacts what others owe, so transactions must be carefully tracked.
Where Do Medical Coders Work?
Medical coders are employed in a broad range of settings, including:
Hospitals generate billions of invoices. They hire teams of billing and coding specialists to make quick work of the reimbursement process.
Working in a busy hospital, you’ll collaborate with patients, doctors and colleagues to file insurance claims and manage payments. It’s a fast-paced, challenging work environment with many opportunities for advancement. You’ll learn something new every day.
Many doctors hire two full-time billing specialists for every three providers in a practice. You’ll be as busy as you would be in a hospital, but the work is less complex. Instead of focusing on a single task, you’ll be a jack-of-all-trades, managing the billing process from start to finish for your assigned patients. It’s the ideal setting for new graduates with prior experience in accounting or customer service.
Medical Billing Services
Some doctors are outsourcing their billing needs to third-party services. Cost-effective and efficient, it allows physicians to separate the business and clinical aspects of their jobs.
Medical billing services handle high volumes of claims. You’ll work with a team of colleagues with similar skills. Most patient contact is by phone. An energetic environment, it’s more like a bank than a medical facility and a perfect environment for number crunchers.
Working for an insurance company, you’ll review medical claims for accuracy, researching errors to help determine coverage. Good communication and coding skills are a must.
Public health officials analyze global disease trends using the codes found on insurance claims. Government-employed coding specialists assist public health departments by collating data. It’s an exciting role for data-driven graduates.
How Do I Get My First Job as a Medical Coder?
The field has grown too complex, and doctors are too dependent on reimbursement to leave filling out claim forms to untrained employees. Instead, they seek educated applicants with proven skills that can work without close supervision and costly on-the-job training. Without higher education, you’ll struggle to compete against experienced candidates.
But the good news for those who want to get into the field is that a 9-month vocational school program is all you need to qualify for entry-level positions. You’ll graduate with a diploma, and your resume will shine.
What Will I Learn in a Medical Billing and Coding Program?
You’ll learn everything you need to know for success as a medical billing and coding specialist, including:
Coding specialists research health data, so it’s important to understand common medical terms. You’ll learn how to decipher words, not by memorizing them, but by breaking them down into parts. Designed specifically for coders, this class will hone your research skills. You’ll be comfortable reading charts without a dictionary on standby.
Anatomy and Physiology for Coding Specialists
Some knowledge of anatomy and physiology is a must for medical coders. This course is foundational and far less in-depth than what clinical staff needs. Topics include the major body systems, medical conditions and treatments associated with each. A passing grade means you’ll be able to research records and code insurance claims with confidence.
Every medical symptom, diagnosis and service has a corresponding code. Diploma programs cover the three most common coding systems, ICD-10, CPT, and HCPCS. You’ll learn the ins and outs of each including research tips.
Electronic Health Records
Electronic Health Records (EHR) are the meat and potatoes of coding. As computerized versions of patients’ charts, they contain integrated medical and billing information. In this course, you’ll learn to retrieve, store and archive data as you fill out claims and post payments.
Health Insurance Principles
Healthcare isn’t your average business. Funding and reimbursement are complicated. This class explores the revenue cycle from billing to final payment. Topics include health insurance principles, government and commercial policies, group rate adjustments, billing law, and collections. You’ll learn how to apply payments, subtract discounts, and other insurance reimbursement tasks.
What Are the Benefits of Attending a Vocational School Diploma Program?
The value of a vocational school diploma program surpasses a paycheck. Benefits include:
A Comprehensive Education
You don’t need to go to a 4-year college to get top-quality training. Vocational school programs are short but no less comprehensive in the core field of study. You’ll be work-ready in months with the practical skills employers are looking for.
A Competitive Advantage
You don’t need a professional license to work as a medical coder but breaking into the field is almost impossible without higher education. In a competitive marketplace, a diploma makes you a more attractive job applicant and could qualify you for better positions.
A Stepping Stone
The best way to climb the career ladder is through experience and education. Coders with the most training will move into supervisory positions first. A diploma not only qualifies you for entry-level work, but it’s also a stepping-stone to higher learning. Once you have a job, you can earn money and continue your education. Top coders have college degrees.
Becoming certified as a medical billing and coding specialist is a career booster. Every credential you earn underscores your commitment to the field. Vocational school programs cover all the topics on the exam, so you’ll have confidence when exam day comes.
Vocational schools are laser-focused on helping graduates find jobs. They form partnerships with area businesses and are among the first to know when jobs are available. As a vocational school student, you’ll be in the right place at the right time. Some schools offer placement services for a lifetime.
Starting a new job without experience or training is a recipe for failure. Some people succeed, but it’s tough. Vocational schools work hard to simulate the work environment. Class time feels more like a job. You’ll learn hands-on, building confidence by tackling real-world case studies, so you won’t feel like a small fish in a big pond when you begin your new career.
While other industries fade, medical coding will be needed for years to come. With the growing population and baby boomers living longer, the result is more opportunity in healthcare. In an uncertain world, the healthcare field offers a secure and rewarding future.
Want to Learn More?
The Medical Billing and Coding training program at Peloton College provides students vital knowledge in Medical Terminology and Understanding Health Insurance Claims and prepares students to be able to work with and maintain electronic health record systems in the health care industry. Graduates of this Medical Billing and Coding training program will also be eligible to sit for the Certified Electronic Health Records Specialist (CEHRS) Certification or the Certified Billing and Coding Specialist (CBCS) Certification.
The mission of Peloton College is to be the premier provider of hands-on training and education by providing students and graduates with the necessary skills to secure occupational careers. Contact us today to learn more.