What Does a Medical Biller and Coder Do?

The health care industry in America is a complex industry with many different channels through which medical procedures and supplies are paid. These include employer-sponsored health plans, Medicaid, and individual health care accounts. Many people use a variety of sources to support their health care needs. Most insurance contains a variety of deductibles and co-pays designed to discourage unnecessary medical care and to make plans cheaper for healthy individuals. Many employers require their employees to contribute to their medical plans, especially if they want the premium plan offered by their employer. The government subsidizes care for many individuals and helps other through tax breaks and other mechanisms. All of these interlocking systems need educated professionals to sort through the rules and regulations of different institutions. Medical billers and coders should play an important role in the reform of record keeping that seems so vital to the sustainability of the current system. What do medical billers and coders do?

Medical billers must know all of the most current medical codes in order to analyze a patientís medical records, often for an insurance company, and to produce invoices and bills for the stakeholders involved. Medical billers are then responsible for the accuracy of the information in the bills. Stakeholders include insurers, patients, and the government. Medical billers are responsible for knowing how to use the specific software required by their employer. They might learn to do so through on-the-job training, but there is usually an expectation that they will have come across the tools of the trade at a medical billing degree program. Medical billers respond to questions and complaints from patients, other insurers, and doctors. They are responsible for confirming and reporting the information to any government agencies that oversee their industry. Medical billers may also work for hospitals or other health care institutions.

Medical coders, as opposed to medical billers, work on the health-care-providing end of the spectrum. While the two functions are sometimes encapsulated into a single job, coders analyze the diagnoses of doctors and specialists. They determine the proper code, based on the most current coding system being used (there are several), to place on a course of treatment and the procedures and medicines needed for it. This includes lab tests, prescriptions, miscellaneous supplies like bandages, and patient care. Coding is vitally important because it is the lingua franca, or common language, of the health care industry. Medical billers communicate with medical coders through these abstruse medical data.

Medical billers and coders may also be called upon to audit the procedures and repeated care of a particular patientís medical records. They serve a regulatory function, protecting both the insurance company and the patient from fraud. They may even work for government agencies to check the medical records of a group of patients to ensure all billing is necessary and above board. They may also be called upon to help in medical reform, streamlining the coding and billing process.

The various systems of coding used nationwide are taught in medical billing and coding degree programs. There are both associateís degrees and bachelorís degrees for medical billers and coders. Most programs teach both disciplines simultaneously, giving graduates a lot of flexibility in employment and paths for career advancement. Demand for medical billers and coders should remain robust into the next decade as the pace of health care reform heats up. Medical billers and coders should keep their skills current by signing up for certificate course in different coding system. They can also continue their professional development by joining an association of medical billers or coders.

Last Updated: 05/22/2014