How to Become a Medical Biller and Coder in Florida

Medical billing is the process by which a doctor or hospital receives payment for their services.  Medical coding is one step of the medical billing process, during which the treatment is assigned a special code used by insurance companies to process a claim.  While medical billing and medical coding are technically two different jobs, they are often done by the same person.  That’s why training programs often group these skills under a single program titled “Medical Billing and Coding” or “Health Information Technician.”

Career Overview

Medical coding is a surprisingly complicated procedure. It requires broad medical knowledge that encompasses various forms of treatment, diseases and thousands of different medical codes.  Insurance companies use these codes in their investigations and the payment of any associated costs.  As per the American Academy of Professional Coders (AAPC), medical coders need to be familiar with different types of insurance plans, regulations, compliance, and the coding community’s three critical resource books: CPT®, HCPCS Level II and ICD-9-CM along with their corresponding codes and guidelines.

The job of the medical billing specialist is also an important one. When a person receives any treatment, the physician, clinic or hospital responsible needs to get paid. The medical biller collects the relevant information, produces a bill and forwards it to the appropriate person or organization. They are also responsible for maintaining billing records and following up on any queries.

Typical steps of the medical billing process include:

1. The medical biller inputs all pertinent patient  information into a database.
2. The medical coder assigns an appropriate code for the procedure based on the classification system used by insurance carriers.
3. Once a specific code has been assigned by the medical coder, an insurance claim form can then be completed by the medical biller and submitted to the insurance provider.
4. The claim form is then reviewed by a claim’s processor and either approved or denied.
5. If the insurance claim is approved, the insurance company will reimburse the healthcare provider as per the rates set for the specific code that has been assigned.
6. If the claim has been denied by the insurance company, the medical biller must determine the reason why and notify the health care practitioner.  The medical biller then creates an invoice for the patient.
7. Medical billers may also be responsible for collection of unpaid bills and working with insurance carriers to investigate cases of possible fraud.

Career Outlook

As per the Bureau of Labor Statistics (BLS), employment prospects for Medical Billers and Coders are excellent with an anticipated growth rate of about 20 percent through 2018. There are two primary factors responsible for this rate of growth: the aging of the population with the increased demand for health care, along with an expansion of medical testing across all demographic groups  leading to earlier detection and treatment of disease and illness.

Healthcare organizations are one of the largest employers of medical billing and coding specialists in the country. The need for medical attention is increasing and consequently physicians and hospitals are realizing the need for a greater number of skilled front-office staff. Coding and billing will, in particular, be highly sought-after areas for medical professionals.

Educational and Training Requirements

As per the AAPC, there are no mandated education requirements to become a medical biller or coder in Florida. However, the AAPC does advise that there is a specific foundation of knowledge and skill set that can best obtained only by enrollment in and accredited training program. Employers also prefer to hire those who have attended formal training at an accredited program since this attests not only to a candidate’s knowledge of the field, but also to their commitment to this career.  This is particularly important for medical coding, because a medical coder must have deep knowledge of thousands of medical terms and insurance codes, which take time and effort to learn.

Accredited programs are offered in both community and four- year colleges. Obtaining an associate’s degree in Medical Billing and Coding will provide you with a competitive advantage in seeking employment over those candidates with a high school diploma or general equivalency diploma (GED). An associate’s degree will also enable you to start at a somewhat higher salary.

A bachelor’s degree in the field of Medical Billing and Coding will provide you the opportunity to enter the career at a higher level as a Health Information Manager with responsibility for supervising the work of medical billers and coders.

Certificate programs are tailored toward people who already have either an associate’s or bachelor’s degree in another field and undergoing a career change. The length of study will vary from six months to one year depending on whether you participate in the program on a full or part time basis.

Coursework in each of the above-mentioned programs will include anatomy and physiology, medical terminology, clinical pharmacology, CPT coding classification systems and software, medical office management, and insurance claim processing. Most programs will also include a practicum experience that provides students the opportunity to gain “real-world” experience as a medical biller and coder within a hospital setting or private physician office.

The American Health Information Management Association (AHIMA) accredits programs in medical billing and coding.

View a list of medical billing and coding training programs in Florida >

Certification Requirements

As per the AAPC, there are also no mandatory certification requirements to begin a career as a Medical Biller and Coder in Florida. However, a 2005 survey conducted by AHIMA showed that over 73% of employers nationwide perceive certification of medical billers and coders as highly valuable in terms obtaining employment and advancing the professionalism of the field.

Certification as a medical biller and coder may be obtained from either American Health Information Management Association (AHIMA) or American Academy of Professional Coders (AAPC). Upon passing a comprehensive five-hour examination consisting of 150 multiple choice questions administered by both AHIM and AAPC you will be granted certification.

AHIMA will grant the designation Certified Coding Specialist (CCS) credential, while the AAPC will award the credential of Certified Professional Coder (CPC) credential.

Those who are new to the field with less than two years experience will be granted the designation CPC-A (Apprentice) by the AAPC. To obtain full certification as a CPC, you will need to have over two years work experience as a medical biller and coder, submit two letters of reference from employers or one letter of recommendation which verifies that you have satisfactorily completed 80 hours of continuing education over the two years.

For complete details regarding certification by AHIMA including eligibility, application and fees to sit for the exam refer to the CCS candidate guide.

For full details regarding the AAPC certification, visit http://www.aapc.com/certification/cpc.aspx

Salaries of Medical Billers and Coders

The table below provides the median salaries for Medical Billers and Coders in select regional areas of the country. Figures as per Salary.com June 2011.

View a list of medical billing and coding training programs in Florida >