Ten questions answered on medical records, coders, and billing specialists

When it comes to healthcare work, the variety of roles and responsibilities can get confusing.  Medical administration positions also require different skill-sets and responsibilities, depending on the workplace. The recording, coding and billing of patient procedures and diagnoses are an integral part of healthcare clerical, but what kind of tasks do these positions include?

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1. What’s the difference between medical records, coders, and billing specialists?

Medical Coders and Billing Specialists are usually discussed together along with Health Information Technicians, but in fact, they represent three specialized aspects of medical clerical work. As we discussed previously, HIT’s focus is on keeping accurate electronic healthcare records. A coder matches the clinical procedures and diseases to their classification code, while a biller uses these codes to process insurance claims.

2. What are these codes you speak of?

The thousands of possible medical procedures and diseases are each designated a unique code. Current Procedural Terminology (CPT) is used for procedure codes while the International Classification of Diseases (ICD-10 specifically) is used to classify diagnoses. Medical Records Coders are responsible for assigning each disease or procedure the correct code, while Medical Billers are responsible for entering these codes into specialized software and making insurance claims.

3. Are these specific positions or a skill-set?

Who undertakes these roles depends largely on the workplace: there may be a position specializing in each aspect, all three jobs may be rolled into one, or multiple people may share the responsibility. Regardless of your specific job title, if you work in healthcare administration a knowledge of these codes and how to apply them could prove the difference when you want to advance your career (see the Payscale Career Path graph below).

4. In what ways are these positions similar?

All of these positions predominantly occur back-of-house, meaning that you don’t often deal with patients directly unless it is part of a more general medical secretary or medical assisting role. This doesn’t mean you don’t get to work with others though; you’ll still have to liaise with medical professionals, clerical staff, and insurance companies. Accuracy, confidentiality and attention to detail are vital to any healthcare clerical role, and these positions are no different. You will also need to have a firm understanding of technology, including the specialized software that is used to record data.

5. How are these positions different?

These are the specific tasks assigned to each skill set.

Records

  • Enter and file clinical, clerical and accounting information
  • Manage electronic records databases
  • Retrieve information on request

Coders

  • Analyse patient records to find procedures and results from the healthcare team
  • Record the procedure or diagnosis code for those services
  • Accuracy is essential as this is used when patients process insurance claims.

Billers

  • Enter codes from patient records into appropriate software
  • Process insurance claims, with a thorough understanding of the insurance claims process and requirements
  • Follow correct procedures and format for billing information to ensure all information and documents are provided to insurers

6. What are the job prospects?

As a subcategory of Health Information Technicians, the opportunities are the same with aging populations and expanding insurance coverage expected to push a 15% growth in positions available. It is unlikely that this demand will slow anytime soon.

7. What education and certifications do I need?

Over 50% of these positions are held by people who have complete high school and/or technical college. The more certifications you have, the better your chances, both of getting a job and progressing in your career. If you want to have a complete set of certifications the National Healthcareer Association Certified Electronic Health Records Specialist (CEHRS), Billing & Coding Specialist Certification (CBCS) and Medical Administrative Assistant Certification (CMAA) are an important place to start. The HIPPA Privacy exam is another one to consider. It is recommended that you undertake training before taking these exams, as they can be quite difficult. The Health Information Specialist program prepares you for these examinations while also teaching allied health math, computer fundamentals and electronic medical records, medical terminology, anatomy and physiology, medical law, ethics, CPR, coding, and insurance billing and reimbursement.

8. Where would I work?

The vast majority of people working in these positions work in physicians offices. They also work in hospitals, nursing homes, and other health care services, along with insurance companies. The majority of your time is spent at a desk or with your head buried in patient notes. But you will also get the opportunity to work with a diverse team, including physicians, nurses and other health professionals, along with other clerical and assistance staff.

9. What type of jobs should I apply for?

Job opportunities for Medical Records (including billing and coders) are plentiful. At the time of writing, Glassdoor had over 1700 jobs advertised in the Dallas area over the past two weeks, Indeed had 3000 entry-level positions listed while Career Builder has over 700 positions available in DFW.

These positions go by a variety of names, and some positions require a wider variety of skills than others depending on the workplace. Here’s a selection of job titles to keep an eye out for:

  • Health Information Technician
  • Medical Secretary
  • Patient Access Representative
  • Medical Records Specialist
  • Care Management Support Specialist
  • Medical Records Coder
  • Medical Insurance Claims Auditor
  • Clinical Data Management Specialist
  • Patient Access Representative
  • Client Services Specialist
  • Medical Records Specialist
  • Medical Insurance
  • Medical Office Biller

10. How can I find out more?

For more information on these roles and how CCI Training Center can help you achieve a fulfilling career in healthcare records, coding, and billing, visit our Health Information Specialist page to fill out the form