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Careers in Medical Coding

A medical coding career is for those interested in health care, who are aspiring to a more profitable and higher job position in the area of medical office management. Such individuals can start by becoming a medical coder to progress toward these goals. Moreover, the demands for this profession continues to increase, which means there are greater chances to secure advancement and maximize earning potential over time.

Duties and Responsibilities of a Medical Coder

Medical coders are in charge of coding healthcare claims of patients, which is important in receiving reimbursement from various government health care programs or insurance firms. These professionals work in a medical facility such as the physician's office or hospitals. They also use software programs that allow them to assign diagnosis codes required for insurance billing.

In addition to these tasks, coders are expected to make a thorough review of the claims data. This way, they can be certain that the assigned codes comply with the insurance and legal guidelines. Coders also make sure that authorizations and signatures required for the processing of claims are in place before they submit these documents.

In case of incorrect coding, the claim may be denied upon submission. When this happens, medical coding specialists will conduct further medical records research. Then, the medical billing specialists will communicate with healthcare professionals and insurance firms until the issue is resolved.

Medical Coder vs. Medical Billers

It is common for some people to assume that medical coders and billers have the same job description. However, these are two different professions with their own set of duties and responsibilities. For instance, medical coding specialists also use the Current Procedural Terminology or CPT when they assign codes to the procedure obtained by each patient. They also determine the diagnosis codes after consulting the International Classification of Diseases. By doing so, they can provide an accurate label of the doctor's diagnosis to ensure the accuracy of the assigned codes.

On the other hand, medical billers are tasked to enter the codes into the billing software to ensure the processing of insurance claims. Hence, they should be also be familiar with the ICD-9-CM, HCPCS Level II and CPT codes to enter the data correctly.

Since medical billers deal with insurance firms, they should have a thorough understanding of the claims process. Before they hand the insurance claims for processing, they need to review carefully the proper billing format and make sure that all fields are filled out correctly. All the required documents should also be submitted before filing the claims.

Billers are also responsible for explaining to the patient any co-payments, coinsurance or deductibles required by the insurer. They will also have to make follow-ups with insurance companies and patients to make sure that the claims have been settled. Lastly, medical billers should check with insurance firms and see to it that doctors are paid for the services they have provided.

Medical coders and billers work together to obtain accurate information and correct documentation necessary for the filing of healthcare claims. Overall, these two professions are critical to the cash flow of healthcare providers. These jobs may be handled by one individual or two people, depending on the size of the facility where they work.

Educational Requirements

Those who aspire to become a medical coder should complete a program that would entitle them to obtain an associate's degree in health information technology or medical coding, as well as other relevant fields. The study program includes classes in basic and advanced levels in ICD-9-CM coding, computer data entry, medical law, physiology, anatomy and medical terminology. Other recommended courses for medical coding specialists include the Current Procedural Terminology, healthcare reimbursement and coding methods and the Healthcare Common Procedure Coding Systems.

Medical Coding Certification

The Certified professional Coder or CPC and the Certified Coding Specialist or CCS credentials are the primary certifications provided to medical coding specialists. The American Academy of Professional Coders (AAPC) offers the CPC credentials while the American Health Information Management Association (AHIMA) provides the CCS certification. It is important to pass at least one of these examinations to obtain a certification required in the medical coding career. Both of these tests will determine an applicant's knowledge in a wide range of subjects including ICD-9-CM, ICD-10-CM, medical terminology, evaluation and management, medicine, pathology, anesthesia, anatomy and radiology.

For those who have minimal training or experience in the medical coding industry, the Certified Coding Associate or CCA and Certified Coder-Apprentice or CPC-A are suitable designation certifications. The CPC is awarded to successful candidates who pass the test and have a minimum of one year work experience in the field. As for the CPC-A, this is given to candidates who pass the exam, yet they do not have any formal training or previous work experience.

The AHIMA also offers a certification exam for aspiring medical coding specialists. This exam is called the CCS-P, yet this is more challenging than the CPC because of the varied test format such as multiple select, fill in the blanks and multiple choice.

Career Advancement

To further advance in your career, you may obtain certification from the AAPC. Be sure to meet certain certification requirements including your current membership to the AAPC, at least two years of professional experience as a medical coding specialist and a test score of 70 percent or higher in the CPC exam. Additionally CPCs who wish to apply for re-certification must maintain their AAPC annual membership, and they need to undertake further studies to submit 36 education units every two years.

Job Outlook for Medical Coders

According to the Bureau of Labor Statistics, there is a 22 percent increase in job demands for medical coders from 2012 to 2022. Considering the increased aging population throughout the world and the computerization of medical files in healthcare facilities, it is expected that more jobs will be made available to medical coding specialists.

However, those who plan to pursue this career should hold at least one certification to qualify for the job. Thus, taking relevant courses and successfully passing the credential examinations can provide a more promising career opportunity for medical coders.

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