The healthcare industry is expanding, and medical billing specialists are needed to manage the growing volume of billing and insurance claims. It’s an up-and-coming field, but what exactly does the job involve and how long does training take? If you’re interested in healthcare finance but can’t spend time in school for a college degree, becoming a medical biller may be the right career path for you.
What Does a Medical Biller Do?
Medical billing specialists manage patient billing and insurance claims for healthcare providers. The majority of medical bills in the United States is paid by health insurance companies, and without claim management, facilities wouldn’t get paid. It’s a challenging but rewarding role.
A medical biller’s responsibilities include:
- Transcribing health information into medical codes
- Filling out insurance claims
- Requesting insurer preapproval for major services
- Troubleshooting rejected claims
- Preparing appeals
- Collecting deductibles and copayments
- Posting cash, credit card and insurance deposits
- Fielding patients’ billing inquiries
- Assisting uninsured patients with applications for financial aid
- Collections
- Creating financial reports
- Balancing cash payments
How Long Does It Take to Learn Medical Billing?
Full-time students can complete a vocational school medical billing and coding program in as little as twelve months, whereas it can take two, four or even six years of training to qualify for some positions in healthcare. It’s an ideal way to further your education when you can’t spend the time and be out of the job market for too long.
Graduates with diplomas qualify for the same certifications as their degree-educated counterparts. Vocational schools can provide similar training faster by sticking to the basics, you won’t have to pay for an elective poetry class. You’ll learn the necessary skills to master an entry-level position and be ready to work on day one.
What Do You Learn in a Medical Billing and Coding Program?
Don’t worry if you don’t have a background in healthcare. Medical Billing and Coding programs are geared for beginners. Topics include:
Medical Terminology
Doctors have a language all their own, and to keep up, you’ll need to translate. Medical terminology courses help students decipher complex words by breaking them down into their essential parts. You’ll learn about prefixes, suffixes and root words, so you’ll be able to determine what the jargon means without memorizing long lists of terms.
Anatomy and Physiology
Anatomy is how the body is made; physiology is how it works. As a medical billing and coding specialist, you won’t be making clinical decisions, but you’ll be pulling data from charts for insurance claims. Knowing more about the body will help you make sense of what you’re reading, building on what you learned in the medical terminology course.
Medical Coding
Medical codes are numeric or alphanumeric sequences representing health information. They’re a type of shorthand that condenses the volume of data on insurance paperwork. Without them, claims could be a dozen pages long and take weeks to process. Programs cover the three major coding systems billing specialists use every day, including:
ICD-10 – stands for the International Statistical Classification of Diseases and Related Health Problems, 10th Revision. It’s a centuries-old coding system dating back to seventeenth-century England and is still used today to classify every known medical condition. The alphanumeric codes are used for disease surveillance and reimbursement purposes.
CPT – Common Procedural Terminology codes, are numeric sequences that describe surgical and diagnostic procedures. Developed by the American Medical Association in the 1960s, they’re used for billing purposes and to monitor health outcomes.
HCPCS – the Healthcare Common Procedure Coding System, HCPCS, is only used in the United States, it’s specific to Medicare, the country’s largest insurer. Established in the early 1980s, it classifies medical products, durable equipment and ancillary services, from anesthesiology to ambulance transportation.
The Revenue Cycle
It’s not unusual for the patient and multiple insurers to pay parts of the same bill. Tracking it is tricky. The revenue cycle describes the many steps necessary to ensure reimbursement, including:
Preregistration — obtaining the patient’s insurance information and requesting the required preauthorization
Registration — establishing a legal medical record
Charge capture — recording healthcare services as billable charges
Coding — assigning the proper medical codes to diagnoses, procedures and supplies
Claims submission — providing insurers with the data they need to make coverage decisions
Patient collections — determining what the patient owes
Third-party collections — accepting payments from insurers or other responsible parties
Utilization review — examining the necessity and outcome of medical services
Medical billing and coding specialists may have a hand in some or all of these tasks, so students get a general overview of the entire process.
Medical Law and Ethics
Healthcare billing is a regulated field. Courses in law and ethics cover important issues, including:
- Patient rights
- Provider liability
- Confidentiality
- Billing practices
- Collections
- Recordkeeping
Students graduate with the knowledge they need to fulfill their legal obligations to patients and protect their employers.
In addition to coursework, students in a vocational school program also learn the soft skills they need for success in the workplace. By interacting with peers and experienced instructors, they gain problem-solving skills and learn how to work with others in a positive, constructive way. Graduates feel confident in their capabilities and ready to grow as billing and coding professionals.
Where Can You Work as a Medical Biller?
Medical billing and coding specialists work in a diverse range of settings, including:
Private Practices
Doctor’s offices hire billing specialists to manage their insurance claims. In an extensive practice with a large billing department, you’ll likely perform exclusive tasks. In a small office, you may be responsible for the claims process from start to finish. It’s an ideal setting for new graduates.
Hospitals
Medical billers working in a hospital collaborate with a team of management professionals from accountants to documentation specialists. The environment is fast paced, but staff gets a bird’s eye view of the inner workings of healthcare finance. It’s the perfect job for someone who wants to learn more about the field and build on their education.
Medical Billing Services
Medical billing services are increasingly popular because they’re efficient. Instead of maintaining a billing department, physicians can outsource their accounting, separating the clinical and business aspects of their practice.
In this setting, you’ll work with similarly trained peers managing insurance claims for dozens of offices. If you prefer crunching numbers to delving into the clinical parts of medicine, this is the job for you.
Insurance Companies
Billing specialists working for insurance companies verify the accuracy of claims. Looking for mistakes is a large part of the job, so it’s essential to be detail oriented. But it’s an interesting way to see financial issues from both sides of the aisle.
Other potential employers include:
- Nursing facilities
- Rehabilitation centers
- Clinics
- Public health departments
Final Thoughts
Medical billing specialists are fundamental to the health industry, without them, care comes to a standstill. With millions of Baby Boomers poised to become healthcare consumers, there’s never been a better time to train for this opportunity. If you’re ready for a new challenge, let a vocational school medical billing and coding program prepare you for a better future.
Do you have twelve months to become a medical billing and coding specialist? Ready to attend Medical Insurance Billing & Coding program at Meridian College? Medical Billing and Coding professionals are responsible for keeping the records, charts and bills in a medical office in order. In addition to the classroom experiences, students will also complete an externship for on-the-job training that will bring them further expertise. Contact us to learn more about.
Contact Meridian College today to learn more about becoming a medical billing and coding specialist.