Medical Billing and Coding

Medical billing and coding is the critical link between the delivery of healthcare services and the insurance companies that reimburse providers for the cost of those services. If you're looking for a fast-paced career in healthcare outside of the clinical environment, you'll want to learn more about what it takes to become a medical biller and coder.

What is Medical Billing and Coding?

We all know healthcare is big business. But when you start wrapping your head around what’s actually involved in tracking and invoicing all of the services and procedures performed in any given year, you can’t help but develop an appreciation for the people who handle the billing and coding side of the healthcare business. In fact, the Centers for Medicare and Medicaid Services (CMS) expects healthcare spending to account for nearly 20 percent of the American GDP by 2028, ringing in at nearly $4 trillion annually. And every one of those billed services is logged as a code universally recognized in the medical community, and associated with a cost that shows up on the invoices submitted to the medical insurance companies that reimburse providers.

Medical billing and coding should not be confused as being the same job. Medical billers serve a different function as medical coders. Some companies require one employee do provide both job functions. However, there are plenty of companies that hire medical billers separately from medical coders.

Medical Coding

Medical coders are responsible for translating medical services into codes. These services are documented in reports, notes and medical transcriptions. It is the function of a medical coder to take all those documents and translate them into codes.

Medical coders are skilled in the health care coding system which is the main tool they use on a daily basis. An expansive knowledge of those codes is a prerequisite in order to work as a medical coder in Illinois. This is also a job that can done independently as medical coders are capable of meeting deadlines on their own.

Medical coders in Illinois are typically very good with numbers. They also possess a keen attention to detail as there is an ongoing need to be extremely precise. There is less personal interaction among medical coders, although they have been known to deal with physicians and other health care professionals on a regular basis. Medical coders are also proficient with the computer software used to assist them in the process of coding.

Medical Billing

The job of a medical biller involves the billing process in a health care facility. Medical billers use medical codes, given to them by medical coders, to put together claims. These claims are itemized and sent to insurance companies. But there is much more to being a medical biller in Illinois.

Medical billers are often required to spend time interacting with both patients and insurance companies. Any discrepancies with a claim are directed to medical billers. As a result, medical billers handle many claim disputes, appeals and the explanation of insurance policy guidelines.

It takes strong communication skills to be an effective medical biller. The job also requires a broad knowledge of insurance policy specifics as medical billers need to be able to explain all the fine details to patients.

Medical Billing and Coding Education Requirements

Those looking to delve into a career in medical billing and coding must first acquire a high school diploma or GED equivalency. Candidates should have some experience in science and algebra as it helps transition to the coursework. There are no post-secondary credits needed to begin the educational process as a medical biller and coder.

Meeting State Licensing Requirements

No state requires its medical billers and coders to obtain a specific license. While there are specific formats and guidelines to follow, state medical boards have not initiated any type of licensing mandates. There have also been no discussions indicating that will change anytime in the near future.

Why Medical Billing & Coding Certificate and Associate Degree Programs?

There is specific training that needs to be completed before companies will hire a new medical biller and coder. The precise nature of the job requires that all medical billers and coders be well versed in their particular area of expertise. Certificate programs are offered through technical institutes, community colleges and vocational schools throughout the country. These programs include courses that cover health insurance reimbursement, the classification of medical data, procedural terminology, and a lot more.

Within these program curriculums, students learn extensive medical terminology along with proper insurance protocol. Several procedures involving medical billing and coding are also taught and are combined with the proper ways to manage computer databases.

You’ll also find full associate degree programs in medical billing and coding, usually structured as Associate of Applied Science degrees that cover all the curriculum you’d find in a certificate program plus general education courses and electives.

Medical Billing and Coding Salary

The U.S. Bureau of Labor Statistics classifies medical billers and coders as medical records and health information technicians. It also lists the median salary at $42,630, with salaries for the top 10 percent coming in at more than $71,000. And with the Bureau expecting to see a job growth rate of 8 percent in the ten-year period leading up to 2029, another 29,000 medical records and health information technicians will be joining the workforce during that time. (May 2019, U.S. Bureau of Labor Statistics salary and job growth estimates for medical records and health information technicians are based on national data, not school-specific information. Conditions in your area may vary. Information accessed January 2021.)