Responsibilities of a Medical Coding Specialist

Medical coding specialists will play an increasingly important role in the coming decade as health care records become digitized and standardized. Health care costs have been growing steadily over the last century and are threatening to upend the current system of providing health care in the country. One of the major reforms to health care on which politicians and medical professionals tend to agree is streamlining patient records and information. One of the areas that insurance companies, hospitals, HMOs, and the government will all need help with in the future is medical coding. Understanding what a medical coding specialist does, and why, might put you in a position to take advantage of a growing employment opportunity; medical coding specialists have responsibilities beyond knowing the proper code.

The term medical coding specialist covers those with a degree and a license to practice medical coding. Medical coding is the assignment of a uniform, digitized, specific code to every medical diagnosis, disease, and injury. Coding is basically the common language of health care professionals and the insurance industry. Medical coding specialists are communicating between doctors who give diagnoses and treatment and the insurers who are responsible for determining coverage, deductibles, and other financial imperatives of health care. Coding specialists must be familiar with the latest software and changes to the codes used.

Medical coding specialists are needed at all points along the billing spectrum. Hospitals have medical coding specialists working in-house to determine how a medical diagnosis is translated into the jargon of the insurance industry. Analysts work at insurers and hospitals to determine the costs and coverage of specific diagnoses, including medicines, types of facilities, and the use of specialists. They also work to protect insurers against fraud and to help regulators in the government police the industry. Medical coding specialists work in managed care facilities, doctor’s offices, and residential care units to help manage the records of the chronically ill who require continued and long-term treatment. Finally, coding specialists work in billing departments, communicating directly with patients.

The information that a medical coding specialist deals with is highly technical and specialized. In order to succeed in medical coding, one needs the right education and professional training. Many medical coding specialists have an associate’s degree or a bachelor’s degree in medical coding and billing. Degrees often combine these two disciplines into one course of study. Classes will be highly specific, covering the different coding systems used throughout history and the few that are still used in the United States. Diagnostic, clinical, and procedural codes must be memorized.

There is also a discussion of the stakeholders in the system. Degree candidates discover the people responsible for decisions—physicians and clinical personnel that make diagnoses. They chart the financial planners, human resources managers, and accountant that use codes for planning. Because of the solitary nature of coding, many courses are available for completion online, making degrees and certificates flexible and convenient. Once finished with a degree, medical coding specialists should be prepared for professional certification and employment.

Medical coding specialists might consider joining a professional association. Professional associations offer classes to keep current with the changing rules of the workplace. In addition, they offer medical coding specialists the opportunity to become involved in changing and improving the current coding system. Members have opportunities to network, lobby, and grow their skills to advance in their careers.

Last Updated: 05/22/2014