Medical Insurance Billing and Coder

Medical services and procedures are very expensive, yet very necessary for many people. Instead of covering all of these expenses out-of-pocket, however, the majority of patients today carry medical insurance to help pay for the bulk of their medical fees. After paying a co-pay or deductible, many patients are relieved to know that their insurance companies will reimburse their physicians.

Before a claim is sent to an insurance company for reimbursement, though, patients’ diagnoses, procedures, and treatments are first assigned codes. These codes are used to help health insurance employees quickly identify medical procedures and treatments. By identifying medical services quickly, medical insurance employees can determine if a particular service is covered under patients’ policies and help ensure prompt physician reimbursement.

Medical coders that work in insurance companies aren’t usually responsible for coding patient medical charts and records, but interpreting them. They may also be called claims analysts. This allows the insurance company to reimburse a medical facility the proper amount of money each time.

The world of medicine is growing by leaps and bounds every year. More and more people are coming to realize the important of proper health care, and in turn, the need for medical insurance. With more people focused on their health and medical insurance becoming more common, choosing a career as a medical insurance coder is a smart career move. Not only will you be rewarded with an impressive salary, but you will also find that there is no shortage of jobs for qualified medical coders.

Duties and Responsibilities

Medical coders employed by medical insurance companies will review coded claims from physicians, hospitals, and other healthcare facilities. They check these coded documents to ensure that proper medical codes were assigned. They will also interpret the code and access patients’ policies to determine if their policies cover the services being billed for.

In some cases, a medical insurance coder may need to contact a medical facility or patient for clarification. For instance, they may request more information or need assistance in clearing up a possible coding problem. Medical insurance coders may even need to travel to various medical facilities to review patient records.

Once the coder has all of the necessary information, he or she can then accept, reject, or deny the claim. Some medical insurance coders may even be responsible for overseeing and processing payments.

Various medical codes are used in medical coding, and coders employed by medical insurance companies need to be familiar with the most common types of medical codes. These include International Classification of Diseases (ICD), Current Procedural Terminology (CPT), and Diagnosis-related Group (DRG). These coders should also be willing to keep up with any changes or updates to these codes.

Necessary Skills, Education, and Experience

Attention to detail and speed are two common qualities that good medical insurance coders possess. If you’re planning to pursue a career in this field, you should also be very computer savvy, as this job requires the use of specialized computer software.

The minimum education requirement for a medical insurance coder is usually an associate degree in medical coding. With this degree, you can take examinations and become a Certified Coding Specialist (CCS), Certified Professional Coder (CPC), or Registered Health Information Technician (RHIT). If you choose to earn a four-year bachelor’s degree in this area, you can also choose to become a Registered Health Information Administrator (RHIA).

Along with the proper education and credentials, medical insurance companies will also usually look for applicants with at least a few years of relevant work experience. Obtaining this experience can be difficult, particularly if you’re fresh out of school. To do so, you should consider completing an internship program or working as a medical coder in a physician’s office or hospital.

Tips for Getting a Job as a Medical Insurance Coder

Medical insurance coding jobs are often listed in newspaper Help Wanted sections and on online job boards. Some medical insurance companies may even list openings on their own websites, and staffing agencies can also help connect you to potential employers.

Create a professional coding resume to use during your job hunt. Your resume should highlight your qualifications, including your education, certifications, and experience, along with any relevant job-related skills and accomplishments.

A professional letter of reference also goes a long way when trying to land a medical insurance coding job. These letters can be from professors or past supervisors whom you’ve worked closely with in the past.