21 Essential Skills for Success in Medical Billing & Coding

Medical billing and coding specialists play a crucial role in the health care industry, helping to ensure that medical facilities deliver the best possible care. To excel in this field, specialists need a unique blend of technical and interpersonal skills to translate health care services into standardized codes used for billing purposes, maintain accurate patient records, and manage insurance claims. 

If you’re considering a career move into medical billing and coding, discover the 21 essential skills these specialists need to succeed.

What Is a Medical Billing and Coding Specialist?

A medical billing and coding specialist serves a critical function in health care settings by translating health care services into standardized codes for billing purposes. 

Using standard coding systems such as the International Classification of Diseases (ICD-10) and Current Procedural Terminology (CPT), medical billing and coding specialists convert patient diagnoses, procedures, services, and equipment into codes that any health care or insurance professional can understand. Once health care services are coded, these specialists submit claims to insurance companies for reimbursement. The codes are also used for statistical purposes and maintaining accurate patient records.

Accuracy is paramount in medical billing and coding. Health care providers are only human, and may sometimes enter incorrect patient information into the electronic health records (EHR) systems. Medical billing and coding specialists must verify and ensure that all patient records are accurate to prevent errors that could lead to claim denials or delays in reimbursement — or worse, ineffective patient care or treatment.

Therefore, medical billing and coding specialists must work closely with health care providers to clarify diagnoses and procedures. They also communicate with insurance companies and patients to resolve any billing issues, ensuring that claims are processed smoothly and payments are received on time. 

Compliance with health care regulations and laws is a crucial aspect of the job. Specialists must stay updated on the latest changes in coding standards and health care regulations to ensure compliance. They must also be proficient in billing software and EHR systems, which hold all patient information recorded by health care providers. To keep up with changes in coding standards and health care regulations, medical billing and coding specialists often pursue continual learning and professional development opportunities relevant to their field.

Medical billing and coding specialists can work in a wide variety of health care settings, including at:

• Hospitals
• Physicians’ offices and clinics
• Insurance companies
• Long-term care facilities
• Ambulatory surgical centers
• Rehabilitation centers
• Home health care agencies
• Specialty medical practices (e.g., dermatology, cardiology, etc.)
• Dental offices
• Mental health facilities
• Public health organizations
• Government agencies (e.g., Medicare and Medicaid)
• Independent billing and coding service companies
• Remote or telecommuting positions

This wide range of work environments offers flexibility and opportunities for specialization within the field. Whether in a bustling hospital or a remote home office, medical billing and coding specialists are essential to the efficient operation of health care services, ensuring that providers are compensated and patient records are accurately maintained.

13 Technical Medical Billing and Coding Skills

Medical billing and coding specialists need a combination of specific technical (hard) skills as well as interpersonal (soft) skills. 

The following technical skills are almost universally required for the job:

• Understanding of medical codes (ICD-10 and CPT): Medical coders use the ICD-10 and CPT coding systems to accurately document patient diagnoses, procedures, and services. These codes are essential for creating uniform and standardized records used for billing, research, and statistical purposes.

• Insurance knowledge: Knowledge of insurance processes and policies enables medical billing specialists to correctly submit claims and handle denials. They must understand various insurance plans, coverage details, and reimbursement procedures to ensure that health care providers receive payment.

• Basic bookkeeping skills: Medical billing involves managing financial transactions, including invoicing patients and recording payments. Basic bookkeeping skills are crucial for maintaining accurate financial records.

• Medical terminology: Proficiency in medical terminology allows coders and billers to accurately interpret health care documentation and apply the correct codes. This knowledge is essential for communicating effectively with health care providers and ensuring accurate billing.

• Knowledge of alternative coding systems: Beyond ICD-10 and CPT, medical coders need to be familiar with other coding systems like HCPCS (Healthcare Common Procedure Coding System). This broad knowledge ensures they can code a wide range of medical services and supplies correctly.

• Analytical skills: Analytical skills help specialists review medical records and documentation to identify the appropriate codes. They also analyze claims data to spot patterns, detect errors, and improve billing processes.

• Problem solving: Problem-solving skills are crucial for resolving billing issues, such as denied claims or discrepancies in patient records. Specialists must identify the root cause of problems and find effective solutions to ensure accurate and timely reimbursement.

• Billing and coding software: Familiarity with billing and coding software streamlines the coding and billing process. Specialists use these tools to input codes, submit claims electronically, and manage patient billing records efficiently.

• Knowledge of ethical and legal compliance: Understanding health care regulations and ethical standards ensures that medical billing and coding practices comply with laws such as HIPAA (Health Insurance Portability and Accountability Act). This knowledge helps avoid legal issues and maintain patient confidentiality.

• Computer proficiency: Proficiency with computers is essential for using EHR systems, billing software, and other digital tools. This enables specialists to efficiently manage and process large amounts of data.

• Commitment to continual learning: The health care field is constantly evolving, with frequent updates to coding systems, regulations, and technology. A commitment to continual learning helps specialists stay current with industry changes and maintain their expertise.

• Attention to detail: Attention to detail is critical for accurately coding medical records and submitting claims. Small errors can lead to claim denials, delays in payment, or compliance issues, so precision is essential.

• Organization: Strong organizational skills help specialists manage multiple tasks, such as coding records, submitting claims, and following up on unpaid invoices. Good organization ensures that the billing process runs smoothly and without error.

8 Soft Skills for Medical Billing and Coding

While medical billing and coding may seem like a strictly technical job, having strong interpersonal skills ensures that specialists can manage their own responsibilities while providing excellent service to both patients and health care providers.

• Customer service: Customer service skills are vital for interacting with patients regarding their bills, insurance claims, and payment plans. Specialists must provide clear, courteous, and helpful information to ensure patient satisfaction and resolve any billing inquiries or issues.

• Communication: Effective communication skills are essential for working with health care providers, insurance companies, and patients. Specialists need to clearly explain coding procedures, billing issues, and insurance claims to make sure all parties understand the process and requirements.

• Active listening: Active listening helps specialists accurately gather information from patients, health care providers, and insurance representatives to fully understand concerns and resolve issues efficiently.

• Time management and multitasking: Medical billing and coding specialists often handle multiple tasks simultaneously, such as coding records, submitting claims, helping patients, and following up on unpaid bills. Effective time management and multitasking skills are crucial for meeting deadlines and maintaining productivity — not to mention a facility-wide reputation for efficiency.

• Conflict management: Conflict management skills help specialists address and resolve disputes, such as claim denials or billing discrepancies. They need to navigate these conflicts diplomatically to reach satisfactory resolutions for all parties involved.

• Patience: Patience is necessary for dealing with complex billing and coding issues, handling frustrated patients, and resolving lengthy disputes with insurance companies. Specialists need to remain calm and focused to provide high-quality service throughout every interaction.

• Autonomy: The ability to work autonomously is important as medical billing and coding specialists often work independently, managing their tasks without constant supervision. They need to be self-motivated and capable of making decisions to keep the billing process running smoothly.

• Dependability: Dependability is key for ensuring that coding and billing tasks are completed accurately and on time. Reliable specialists help maintain the financial health of health care providers by consistently performing their duties and meeting deadlines.

How To Become a Medical Billing and Coding Specialist

There are multiple paths one can take to becoming a medical billing and coding specialist — and there is no one right way to go about it. A specialist may pursue any combination of the following educational and/or certificate options.   

Formal Education

• High school diploma or GED: This is the minimum educational requirement for entering the field and provides a foundation for further specialized training.

• Postsecondary certificates and diplomas: Many community colleges, vocational schools, and online institutions offer postsecondary certificate and diploma programs in medical coding and billing. These programs typically take between nine to 12 months to complete and cover essential topics such as medical terminology, anatomy, and coding systems (ICD-10, CPT, HCPCS). These programs provide the fundamental skills required to begin a career in medical coding.

• Associate degree: For those seeking a more comprehensive education, pursuing an Associate of Applied Science (AAS) degree in Health Information Technology or a related field is a good option. Available at community colleges and technical schools, these programs usually take about two years to complete. They offer in-depth knowledge and training in medical coding, billing, and health information management, often including practical experience through internships or externships.

Professional Certification

• Certified Professional Coder (CPC): Offered by the American Academy of Professional Coders (AAPC), the CPC certification is one of the primary credentials for medical coders. It demonstrates proficiency in medical coding and a commitment to the profession, making it highly valued by employers.

• Certified Coding Associate (CCA): The CCA certification, offered by the American Health Information Management Association (AHIMA), is suitable for entry-level coders. It provides a solid foundation in coding and prepares individuals for various coding roles in health care settings.

• Certified Coding Specialist (CCS): Also offered by AHIMA, the CCS certification is geared toward more experienced coders, particularly those who work in hospital settings. It signifies a higher level of expertise and is ideal for those looking to advance their careers.

• Other specialized certifications: There are additional specialized certifications available for those looking to focus on specific areas of medical coding:
  • Certified Inpatient Coder (CIC)
  • Certified Outpatient Coder (COC)
  • Certified Medical Reimbursement Specialist (CMRS)

Continuing Education

To maintain certification and stay current with the ever-evolving field of medical coding, professionals are required to engage in continuing education. Changes in coding standards, health care regulations, and industry best practices necessitate ongoing learning. Many certifying organizations require professionals to earn continuing education units (CEUs) to retain their credentials.

Is Medical Billing and Coding Right for You?

For those who desire to work in health care but don’t see themselves in a clinical role, there are dozens, if not hundreds of support roles available. If you have a keen eye for detail, strong organizational abilities, and enjoy working with both technology and people, a career in medical billing and coding could be a great fit. 

To get started on enhancing your professional skill set, consider exploring the health care programs at the USD Division of Professional and Continuing Education, including the Medical Terminology course. This course provides students with a solid foundation in the language of health care, which can then be applied to a wide range of careers and support roles, including billing and coding.

Equip yourself with the skills needed to thrive in medical billing and coding — get started at USD PCE today.

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