OVERVIEW
What is a Medical Billing & Coding Specialist?
Healthcare systems generate vast amounts of data every day. Each appointment, procedure, diagnosis, and lab test becomes part of a patient's clinical record. To process billing and meet reporting requirements, clinical information must be translated into standardized codes.
Medical billing and coding specialists translate medical documentation into universal codes that are used by insurance companies, healthcare organizations, and government agencies. Their work helps providers receive payment while simultaneously ensuring health records are organized and compliant.
RESPONSIBILITIES
What Do Medical Billing and Coding Professionals Do?
Rather than providing patient care, medical billing and coding specialists work in the financial and operational side of healthcare. Their efforts ensure services are documented correctly, insurance claims are processed accurately, and providers are paid for the care they deliver. The day-to-day responsibilities involved in a medical billing and coding specialist role include:
- Reviewing patient charts and assigning accurate medical codes.
- Entering coded information into electronic health records (EHRs) and billing systems.
- Preparing and submitting claims to private insurers, Medicare, or Medicaid.
- Checking medical bills for accuracy before they’re sent to insurance companies or patients.
- Verifying insurance coverage and ensuring that required documentation is included with claims.
- Following up on unpaid or denied claims and correcting errors before resubmission.
- Communicating with physicians, nurses, and administrative staff to clarify missing or incomplete information.
- Keeping up with updates on coding guidelines and payer rules that affect reimbursement.
Medical Billing vs. Coding: What's the Difference?
Medical coders are responsible for reviewing clinical documentation and translating diagnoses and procedures into standardized codes. Medical billers then use these codes to prepare insurance claims, track payments, and follow up on denials or outstanding balances until accounts are resolved.
Medical billing and coding can be distinct roles or combined into a single position, depending on the organization's size and structure. Larger hospitals typically separate these roles due to high claim volumes, while smaller clinics and private practices may combine them to reduce administrative costs.
Where Do Medical Billers and Coders Work?
Medical billers and coders typically work in hospitals, physician offices, outpatient clinics, long-term care facilities, and billing companies. Many begin their careers on-site to gain experience with documentation systems and workflows, then move to remote roles once they’ve gained proficiency. A significant number of medical billing and coding professionals work from home.
EDUCATION & BEST DEGREES
How Do I Become a Medical Billing and Coding Specialist?
You can become a medical billing and coding specialist by completing a certificate, diploma, or associate degree program in medical billing and coding or health information management. These programs help you build essential skills in medical terminology, documentation standards, and coding practices. While formal training is not always required, completing a medical billing and coding program prepares you for certification exams and gives you a competitive edge when applying for jobs.
You may also choose to earn an industry certification to strengthen your qualifications.
Many employers prefer or require candidates with industry certifications from reputable credentialing organizations such as the American Academy of Professional Coders (AAPC) and the American Health Information Management Association (AHIMA).
The most widely-recognized credentials in this field include:
- Certified Professional Coder (CPC). The CPC certification is considered the gold standard for physician office and outpatient coding roles. Candidates must pass a 150-question exam covering coding, anatomy, and compliance.
- Certified Professional Biller (CPB). The CPB certification validates expertise in revenue cycles, reimbursement methodologies, claim submission processes, confidentiality laws, and other medical billing fundamentals. It's ideal for experienced billers seeking to expand their employment opportunities and raise their earning potential.
- Certified Billing and Coding Specialist (CBCS). This is another entry-level certification for those who want to prepare for both billing and coding. It’s ideal for roles in small physician offices or private practices where billing and coding responsibilities are combined.
- Certified Coding Associate (CCA). This entry-level certification is a strong starting point for those planning to work in hospitals, physician offices, outpatient clinics, or other healthcare settings. The 100-question exam tests knowledge of coding, compliance, regulatory guidelines, reimbursement, and health information documentation.
- Certified Coding Specialist (CCS). This advanced credential is often required or highly preferred for medical coders working in hospital and emergency department settings. The 115- to 140-question exam focuses on hospital and inpatient coding, complex medical cases, and analytical skills.
- Certified Medical Coder (CMC). The CMC certification verifies proficiency in ICD-10-CM, CPT, and HCPCS Level II coding. It's ideal for experienced outpatient medical coders who want to deepen their skills or advance into auditing, compliance, or managerial positions.
- Certified Outpatient Coder (COC). This credential focuses on facility coding rules and outpatient hospital reimbursement. The 150-question exam covers outpatient facility coding, reimbursement methodologies, compliance and regulatory guidelines, and application of ICD, CPT, and HCPCS codes.
Best Degrees for a Medical Billing and Coding Specialist
While most billing and coding jobs only require a certificate and a professional credential, earning a bachelor’s degree can significantly expand your long-term career options. Bachelor’s degrees that align well with medical and coding positions include:
Health & Nursing
Health Information Management – B.S.
A program designed for future leaders in HIM....
A program designed for future leaders in HIM.
- Time: 61% of grads earned this degree in 36 months or less.
- Tuition: $4,210 per 6-month term.
- Courses: 36 total courses in this program.
Skills for your résumé that you will learn in this program:
- Medical Terminology
- Healthcare System Applications
- Health Information Law and Regulations
- Healthcare Project Management
- Data Analytics and Information Governance
This CAHIIM-accredited program makes you eligible for the RHIA exam.
Business
Healthcare Administration – B.S.
You can become a healthcare industry leader:...
You can become a healthcare industry leader:
Compare with B.S. Health Information Management
- Time: 63% of graduates finish within 17 months
- Tuition: $3,830 per 6-month term.
- Courses: 34 total courses in this program.
Skills for your résumé you will learn in this program include:
- Management
- Communication
- Team Leadership
- Operations
- Scheduling
- Strategic Planning
The online courses in this career-focused business degree program will prepare you with management-level skills and an up-to-date understanding of our healthcare delivery system.
Health & Nursing
Health and Human Services – B.S.
An online health degree program for students who are committed to making a...
An online health degree program for students who are committed to making a difference for patients in a variety of ways.
- Time: 63% of students finish this program in 24 months
- Tuition: $4,210 per 6-month term
- Courses: 35 total courses in this program
Skills for your résumé that you will learn in this program:
- Epidemiology
- Community and Public Health
- Cultural Awareness
- Pathophysiology
- Healthcare Values and Ethics
- Substance Abuse Support
This degree allows you to work inside the healthcare industry, while also directly working with patients who need help.
Health & Nursing
Health Science – B.S.
An online health science program designed for students who want real-world...
An online health science program designed for students who want real-world skills for valuable health careers.
- Time: 63% of students finish similar programs in 24 months.
- Tuition: $4,210 per 6-month term
- Courses: 28 total courses in this program
Skills for your résumé that you will learn in this program:
- Epidemiology
- Disease prevention
- Behavioral health
- Substance abuse support
- Health research
- Medical technology
This degree prepares you with relevant industry skills and experience that will help you move forward in your healthcare career.
SKILLS
What Skills Does a Medical Billing and Coding Specialist Need?
Medical billing and coding require a combination of technical knowledge and strong interpersonal skills. Success in this role depends on both accuracy with systems and the ability to collaborate professionally.
Technical Skills
- Knowledge of medical terminology. Coders and billers must have a solid grasp of medical terminology to interpret provider documentation and translate diagnoses and procedures into billable services.
- Proficiency with coding systems. Medical coders use systems such as the International Classification of Diseases (ICD), Current Procedural Terminology (CPT), and the Healthcare Common Procedure Coding System (HCPCS). to accurately classify diagnoses and procedures.
- Understanding of regulations and compliance. Billers and coders need to know how to follow payer rules, reduce claim denials, and maintain compliance with federal and private insurance requirements.
- Accounting and bookkeeping skills. Medical billers use accounting principles to track payments, reconcile accounts, and manage outstanding balances.
- Proficiency in electronic health records and medical billing software. Much of the daily work in this field involves navigating electronic records and billing software to input codes, submit claims, and monitor reimbursements.
- Data entry and typing expertise. Careful data entry ensures that patient information, coding details, and insurance information are recorded correctly.
- Understanding of insurance processes. A thorough understanding of insurance policies and reimbursement methods enables medical billers to submit accurate claims and effectively handle denials.
Soft Skills
- Attention to detail. Precision in this role is essential. Even minor coding or billing errors can lead to rejected claims or compliance concerns.
- Written and verbal communication. Clear communication allows medical coders and billers to request clarification and coordinate effectively with providers.
- Ability to work independently. Jobs in this field require sustained focus and self-direction, particularly in remote or high-volume environments.
- Problem-solving skills. Medical billers analyze claim denials and documentation issues to identify root causes and resolve issues.
- Time management and organizational skills. Effective time management and prioritization are essential for meeting tight deadlines in this fast-paced industry.
- Discretion and professionalism. Medical billers and coders handle patient and financial information, so they must strictly adhere to confidentiality and ethical standards.
- Ethical judgment. Responsible decision-making protects organizations from improper billing practices and ensures compliance with industry standards
How Much Does a Medical Biller and Coder Make?
$50,250
According to the U.S. Bureau of Labor Statistics (BLS), medical records specialists, including billers and coders, earn a median annual salary of $50,250. Several factors influence salary in this role, including the professional’s certification level, experience, location, and work setting. Specializing in a specific area, such as surgical coding, can increase earning potential. According to research from the AAPC, individuals with a relevant certification earned approximately 21% more than noncertified medical billers and coders.
What Is the Projected Job Growth?
7%
The BLS projects that the employment of medical records specialists will grow by 7% from 2024 to 2034, which is faster than the average for all occupations. The continued adoption of EHR systems has increased the volume and complexity of digital documentation that must be reviewed and coded by skilled professionals. The shift to value-based care models has also increased the need for accurate documentation and reporting. Additionally, the expansion of telehealth services has introduced new billing scenarios and coding requirements, further driving demand for coding expertise.
Although AI tools can assist with code suggestions and workflow automation, human judgment remains essential for interpreting nuanced clinical documentation and ensuring compliance, meaning medical coders and billers will continue to be in high demand.
Frequently Asked Questions About Becoming a Medical Billing and Coding Specialist
On average, it takes 6 to 24 months to become a medical billing and coding specialist. The timeline varies depending on whether you pursue a certificate, industry certification, or associate degree program.
Many medical billing and coding jobs are remote positions. However, some employers may require on-site experience before allowing remote work.
Many individuals enter medical billing and coding without prior healthcare experience.
While medical coding and billing can involve deadlines and productivity expectations, many professionals appreciate the ability to work remotely and maintain a consistent schedule. The role also offers a clear sense of purpose and has low barriers to entry.
Accelerate Your Healthcare Career with a Degree from WGU
Whether you're interested in medical billing and coding, healthcare administration, nursing, or other healthcare roles, WGU can help you develop the skills needed for success in the field. WGU's accredited healthcare degrees are competency-based, allowing you to earn a reputable degree without compromising your personal and professional responsibilities. Speak to an Enrollment Counselor today to learn more!
Our Online University Degree Programs Start on the First of Every Month, All Year Long
No need to wait for spring or fall semester. It's back-to-school time at WGU year-round. Get started by talking to an Enrollment Counselor today, and you'll be on your way to realizing your dream of a bachelor's or master's degree—sooner than you might think!
Next Start Date
{{startdate}}
Interested in Becoming a Medical Billing and Coding Specialist?
Learn more about degree programs that can prepare you for this meaningful career.
