Working World

“I tell my students that if you don’t know your ischium from your elbow you shouldn’t code,” said Kathy O’Brien, MBA-HM, CPC, CPC-H, an instructor in the medical billing and coding department at L.A. College International. “You need to know anatomy and physiology of the body to understand the job.”

While medical billing and coding is essentially an administrative career path that involves front office duties in clinics, hospitals and medical groups, because it’s linked to the healthcare industry there is much more to the job. It involves a fair amount of detective work, a love of details and fact-checking.

“A common cold can be known as rhinitis; the student needs to know that,” Kathy said. “In order for the bill to get paid, whatever was wrong with the patient has to match up with what was done by the physician at the doctor’s office. Every procedure has to be justified before a claim is filed, otherwise the bill would not get paid.”
    
In the Classroom

In the L.A. area, programs range anywhere from 32 weeks for a certificate to two years for an associate degree. Then comes the national certification exam through the National Center for Competency, which must be passed in order to work in the medical billing and coding environment.

Course topics include medical terminology, anatomy, international classification of diseases, coding procedures, government coding, disabilities coding, medical documentation rules, coding workers’ compensation, office and collections strategies, hospital billing, keyboarding and computer applications, CPR and first aid, business mathematics, medical law and ethics, critical thinking and English skills — to name a few.  Externships are also part of the programs and give students a chance to get hands-on training before actually joining the workforce.
    
On the Job

A typical day in the life of a medical biller and coder will depend on the work setting. Standard jobs are with billing and coding companies, medical offices, insurance companies, hospitals, dental offices and collection agencies. Anywhere that medical services are being charged, you will find a certified biller on the scene. Most will be working with medical records or code sheets on a daily basis, and some will cross-train to perform additional front office duties.

Kathy said that some of her students “…went to work for hospitals as unit secretaries, in admitting and the ER; operating room coders; nursing homes; and in many different kinds of physicians offices.”

“What’s different [about this healthcare profession] is that skilled and professional billers can open their own businesses and work out of their homes to manage billing responsibilities for two to four medical or doctor’s offices,” said Tim O’Neil, campus director at Valley College of Medical Careers. “One or two successful years in the business can give a biller enough experience and expertise to launch their own business if they are entrepreneurial and motivated to run their own business.”

Monireh Karimkhan, BSN, CPI, CMA, NCMA, NCMOA, NCICS, is the health claims examiner/medical biller program director at American Career College. According to her knowledge and experience, the qualities of a successful biller and coder are as follows: ”You have to be a people person, outgoing. You have to be good at multitasking, know how to talk and realize when to ask for help. You need to be detail-oriented, have great customer service skills, excellent written communications skills and you cannot be shy.” Other required traits include dependability, honesty, professionalism and compassion.

Kim Lott, a current student of Monireh’s, said, “I was doing a lot of retail and I was really tired of it. The odd hours and customer service really took its toll on me. I’ve always been interested in the medical field, so when I became unemployed due to this economy I began researching my options in the medical field. I was looking for something quick in terms of training and this was it.”

Kim is not alone. Many students that enter the program come from careers that are experiencing major cutbacks in employees due to the economy, or people who graduated with a bachelor’s degree in something they don’t want to pursue.

Medical billers and coders can expect to start at $15-$18 per hour depending on the job setting and past employment history, as well as resume and poise during the interview. All of the schools mentioned provide training in resume and interviewing skills and offer help with job placement. Federal financial aid is also available for those who qualify.

Are you ready to go for it?

Sidebar

Learning the Lingo
(Courtesy of Medical Billing&Coding Net)

If medical billing and coding is the path for you, be prepared for learning a new language. here are some common terms you’ll see in a day’s work:

• Assignment of Benefits (AOB) – an authorization directing an insurer to make payment directly to a provider of benefits, such as a physician or dentist, rather than to the insured.
• Co-payment – a set fee the member pays to providers at the time services are provided
• Deductible – a portion of the covered expenses that an insured individual must pay before insurance coverage with co-insurance goes into effect
• Explanation of Benefits (EOB) – the coverage statement sent to covered persons listing services rendered, amount billed and payment made
• Health Insurance Portability and Accountability Act (HIPAA) – federal legislation that provides easier portability of medical information by standardizing electronic transaction and code sets, and enacting additional patient privacy provisions
• Out of Network (OON) – coverage for treatment obtained from a non-participating provider
• Premium – amount paid periodically to purchase health insurance benefits

Resources

American Academy of Professional Coders
American Career College
L.A. College International
Medical Billing&Coding Net
National Center for Competency Testing
Valley College of Medical Careers

Katy Allgeyer is an artist and freelance writer. She is a columnist for Working World and Working Nurse magazines and her features have appeared there and in Feng Shui Times, The Art of WellBeing, You & Me Magazine and others.