Medical billers and medical coders are the healthcare professionals in charge of processing patient data such as treatment records and related insurance information. Medical insurance billers and coders are tasked with coding a patient's diagnosis along with a request for payments from the patient's insurance company. Medical coding is the first step in the medical billing and coding process. It involves using ICD 10, ICD 9, CPT and HCPCS codes.
Medical Billing Skills
While medical billers will be familiar with some medical codes and the process used to determine them, their primary function is to make sure that coding information is properly presented, that bills are correctly calculated and formatted, and to follow up and work with clients or insurance companies as necessary. Key skills in this role include:
Medical billers may deal with any number of types of people in a day – from providers to patients to insurance representatives – and must speak the language of all of them. They should be comfortable with the shorthand and terminology of professionals, while being able to translate it into more accessible language for laypeople. They must also be able to clearly document diagnoses, procedures and treatments in written form.
Financial and data analysis skills
Healthcare can be expensive, and when procedures are not correctly documented or billed, it can potentially cost a practice thousands of dollars. Billers need a thorough understanding of how the finances of a physicians’ office or medical facility are structured, as well as how insurance companies’ reimbursement policies work, in order to maximize returns.
Ability to work as part of a team
Medical billers serve as liaisons between physicians, patients and insurance companies, and also work closely with medical coders and other administrative staff. Those who are cooperative, proactive, and solution-oriented usually get the best results.
Understanding of Insurance
Insurance policies can be complex, and medical billers need a thorough understanding of how benefits are typically structured and what exceptions may apply. This helps them to correctly submit bills to insurance to ensure timely payment. They should also know how to read and interpret Explanation of Benefits (EOB) forms issued by insurance companies.
Medical Coding Skills
The jobs of medical coders dovetail with those of medical billers, although in general, coders tend to work more independently. While specific duties can vary depending on whether they work in a small private practice or a large hospital system, professionals in the field share several of the same key skills:
Attention to detail
Tens of thousands of different codes comprise the ICD-10 system recently implemented in the U.S. It’s important to be familiar not only with these categories of codes and their key differences, but also with interpreting patient information in order to select the corresponding codes.
Choosing the correct codes for a patient’s records is not always easy or straightforward. Good coders are skilled at doing the necessary research about conditions, terms or treatments to get accurate information and make decisions accordingly.
Knowledge of medical terminology
Complex medical terms are the everyday vocabulary of medical coders. They have a comprehensive knowledge of the language used to describe human anatomy, physiology, pathology and pharmacology, and can then translate medical conditions and treatments into the codes needed for record-keeping and billing.
Coders may have numerous cases to deal with at any one time, so they must be good at organizing their time, setting priorities, and juggling multiple tasks.
Ability to maintain confidentiality
Because medical coders are privy to individuals’ personal health records and data, they have a responsibility to familiarize themselves with privacy laws that protect patients, as well as with ethical considerations in handling sensitive medical information
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