Medical Coder and Biller

The classification of ailments dates back to the United Kingdom’s 17th century. In 1629, statistician John Graunt analyzed the mortality rate in London from 1662 to 1665 in his book Natural and Political Observations Made upon the Bills of Mortality. The book replaced estimates with real numbers representing epidemiology and public health statistics such as births, deaths, and, more specifically, the causes of deaths in London parishes. This historical work is credited as the start of medical coding and, later, medical billing.

The modern-day role of a certified medical coder and biller is crucial in supporting medical institutions and patients. The primary function of the job is to manage invoices, payments, and insurance claims. Medical coder and biller roles are the direct lifelines from patient services to medical institutions and insurance agencies. 

According to the US Bureau of Labor Statistics (BLS 2022), the job outlook for medical records specialists between 2021 to 2031 is good, growing at an average rate of seven percent. In the same period, 12,300 new positions will be added, and the median salary for a certified medical coder and biller role is $44,660 per year. 

Medical records specialists must be diligently detailed in their daily responsibilities. This role requires workers to manage, organize, and apply daily health codes to information. Medical coding and billing skills are highly sought after, and specialists with both abilities will access most job opportunities. Depending on the size of a medical facility, healthcare providers may prefer to hire one person to fulfill both roles. 

A medical coder takes the physician’s notes and diagnostics and then transfers them into codes that correlate record-tracking and billing. There are generally three sets of regulations used: current procedural terminology (CPT), international classification of disease (ICD-10), and healthcare standard procedure coding system (HCPCS).

A medical biller continues with the medical process after a medical coder has completed coding a patient’s file. The medical biller then creates invoices based on the codes and follows up by sending the information to the patient’s insurance providers. The codes directly correlate to what coverage a specific patient has in their program or not. It’s important to note: medical billers do not code patient files. However, they need to be able to read the codes to review them later before submitting them to insurance, and if required, resubmit with revised codes if the insurance provider denies them. 

The educational background of a certified medical coder and biller includes a high school diploma or GED and possibly an associate’s or bachelor’s degree if the candidate chooses that specific route. Earning a certification, such as the CPC + CPB (Certified Professional Coder and Biller), through the American Academy of Professional Coders (AAPC) is a requirement for candidates seeking work in outpatient service organizations. Having a professional certification in medical coding and billing assures employers that a candidate has completed the necessary training and has the knowledge required for the job. 

Continue reading to learn more about specializations, degree types, admissions requirements, accreditation organizations, and educational programs for the field.

Specializations

Certified medical coder and biller specializations exist within multiple areas of healthcare departments. Specializations do not always require certification for the specific field. However, pursuing a particular avenue within the medical field is both helpful and lucrative later in a career. 

Several organizations certify medical coders and billers. Here is a list of some of the available medical coding and billing organizations and their certifications:

American Academy of Professional Coders (AAPC)

• Certified Cardiovascular and Thoracic Coder (CCVTC)
• Certified Inpatient Coder (CIC)
• Certified Outpatient Coder (COC)
• Certified Professional Coder (CPC)
• Certified Professional Coder and Biller (CPC + CPB)
• Certified Rheumatology Coder (CRHC)
• Certified Risk Adjustment Coder (CRC)

American Health Information Management (AHIMA)

• Certified Coding Associate (CCA) 
• Certified Coding Specialist (CCS)
• Certified Coding Specialist – Physician-based (CCS-P)
• Registered Health Information Technician (RHIT)
• Registered Health Information Administrator (RHIA) 

American Medical Certification Association (AMCA)

• Medical Coder and Biller Certification (MCBC)

National Center for Competency Testing (NCCT)

• Medical Office Administration (NCCT-NCMOA) 
• Insurance and Coding (NCCT-NSICS)

National Healthcareer Association (NHA)

• Certified Electronic Health Records Specialist (CEHRS)

Radiology Coding Certification Board (RCCB)

• Radiology Certified Coder (RCC)

Degrees

Most medical coders and billers complete a post-secondary diploma, certificate, or two-year associate’s degree program in medical coding. Some common medical coding and billing degrees and certifications are as follows:  

• Medical office administration diploma
• Medical coding technical certificate
• Associate of applied science (AAS)
• Associate of applied technology (AAT)

Admissions requirements vary by program, but in general, aspiring certified medical coder and biller students must complete the following to be considered for admission: 

• High school diploma or GED
• Criminal background check 
• Proof of financial solvency

There are two types of accreditation: regional and programmatic. Many medical professions, such as nursing, require students to graduate from programmatically-accredited programs to work legally. However, medical coding and billing professionals need only complete a program recognized at the regional or programmatic level, depending on what is required by an employer. 

Regional accreditation is given by an organization recognized by the Council for Higher Education Accreditation (CHEA). The following are regional accreditation organizations approved by CHEA:

• Accrediting Commission of Career Schools and Colleges (ACCSC)
• Accrediting Council for Continuing Education and Training (ACCET)
• Higher Learning Commission (HLC)
• Middle States Commission on Higher Education (MSCHE)
• New England Commission of Higher Education (NECHE)
• Northwest Commission on Colleges and Universities (NWCCU)
• Southern Association of Colleges and Schools Commission on Colleges (SACSCOC)
• Western Association of Schools and Colleges (WASC)

Programmatic accreditation is given by organizations that verify an educational program’s academic integrity from several angles. Here are some organizations that accredited or recognized medical coding and billing certification and degree programs:  

• American Academy of Professional Coders (AAPC)
• Commission on Accreditation for Health Informatics and Information Management Education (CAHIIM)

Institute of Technology – Medical office administration diploma

The Institute of Technology, Salem, offers a medical office administration diploma, providing a well-rounded coding and billing education. Distance learning and on-campus interactive courses for the next generation. They provide interactive coursework for active individuals. Placement support, questions, and inquiry are welcomed. Graduates are eligible to sit for national exams in medical coding and billing.

Training included in the program covers all of the necessary coursework for job application. Some of the courses offered within the program include but are not limited to medical office procedures, medical records management, communication for health professionals, externship, computerized medical office, administrative office, and professional development. In addition, all students must participate in an externship component, meet immunization requirements outlined upon enrollment, and have training in CPR practices to be eligible for a diploma. 

Admissions to the Institute of Technology require candidates to be eighteen years of age, have a high school diploma or equivalent GED or accredited home school program, and have a clear record with no delinquent loans from other programs or universities. 

• Location: Salem, OR
• Duration: Nine months
• Accreditation: Accrediting Commission of Career Schools and Colleges (ACCSC); Accrediting Council for Continuing Education and Training (ACCET)
• Tuition: $16,858 total (not including fees, books, and supplies)

Idaho State University – Medical coding technical certificate

Idaho State University offers part and full-time programs in medical coding with in-person or online course options available. Upon completing this program, students can transfer into one of three programs: a two-year associate of applied science (AAS) degree in health information technology, a bachelor of applied science (BAS), or a bachelor of science in health science. 

The technical certificate requires 1.5 years and prepares graduates to take the AHIMA Certified Coding Specialist (CCS) exam. Students can begin the program in the fall or spring semester. Many graduates find job positions in medical clinics, insurance companies, health maintenance organizations, law firms, software companies, and computer software vendors. 

The course load incorporates the following list but is not limited to medical terminology, introduction to pathology, principles of drugs and their uses, CPT coding, ICD-10 CM coding, medical law and ethics, professional coding practicum, introduction to reimbursement, and advanced coding and revenue cycle management. Academic plans for course completion are laid out with an academic advisor to cater directly to individual candidate needs. Admissions requirements include a high school diploma or GED, college-level math and English courses qualification, a criminal background check, and a pre-admission meeting with a program coordinator.

• Location: Pocatello, ID
• Duration: 1.5 years
• Accreditation: Northwest Commission on Colleges and Universities (NWCCU)
• Tuition: $7,843 per year (residents); $25,934 per year (non-residents); $11,937 per year (WUE program)

Green River College – Medical coding and reimbursement certificate 

Green River College provides a medical coding and reimbursement specialist certificate that helps students develop their skills with ICD, CPT, and HCPCS level II coding, claims, and insurance for beginning coder and reimbursement positions. After completing the 75-credit certificate, students are ready to enter professional capacities and begin their careers. Future candidates may choose from online coursework or face-to-face classroom experiences. In addition, after completing the program, graduates will become eligible for national exam completion.

The course work includes the following but is not limited to these courses: survey of human anatomy and physiology, medical terminology for office administration, pharmaceutical basics, health information and delivery systems, introduction to ICD coding, introduction to CPT coding, BTAC work experience, work experience seminar, intermediate ICD coding, and intermediate CPT/HCPCS coding. In addition, students must take 20 credits in written communication coursework, oral communication, and human relations. 

Prospective students can submit their application materials online, via email, fax, or postal mail. The application must include a financial bank statement showing a balance to cover the program costs, a $50 non-refundable application fee, a copy of a valid passport and a medical release form, and English proficiency exams outlined on the admissions website. 

• Location: Auburn, WA
• Duration: Five to six quarters
• Accreditation: American Health Information Management Association (AHIMA) 
• Tuition: $7,800

Baltimore City Community College – Coding specialist certificate

Baltimore City Community College program focuses on coding specialist skills and prepares students for positions as coders in hospitals or other healthcare-related fields. Graduates are fluent in coding with ICD-9-CM, CPT-4, and DSM-IV classification systems. The program consists of 37 credits, which takes three or four semesters, depending on how many prerequisite courses students have completed. Graduates are prepared to take exams by the American Health Information Management Association (AHIMA). Once the exam is completed and passed, individuals will be granted certified coding associate (CCA) initials. 

After three years of coding experience, individuals can complete the exam for a certified coding specialist (CCS) certificate or a certified coding specialist- physician based (CCS-P) certificate. Before admissions, candidates must evaluate what prior educational coursework they have completed according to the college website and communicate with an academic advisor to transfer credits that apply to the coding specialist program. 

The coding specialist certificate coursework includes allied health pharmacology, anatomy and physiology II, health information systems, and study of disease processes completed within the first semester. These courses are followed by the second semester, including ICD-10-CM coding principles, CPT-4 coding principles and RVUs/APGs, and computer applications in healthcare. They were summing the first semester up with coding practicum II and advanced ICD-10-CM coding/DRGs and DSM-IV. 

The admissions process involves creating an online account and submitting an official high school transcript with evidence of graduation, a GED diploma, and official college transcripts, if applicable. Applications are completed within two business days, and candidates are notified of acceptance status shortly. 

• Location: Baltimore, MD
• Duration: Three or four semesters
• Accreditation: Middle States Commission on Higher Education (MSCHE)
• Tuition: $110 per credit (residents); $280 per credit (non-residents)

Clark College – AAT & certificate program in medical billing and coding

Clark College is located in Southwest Washington and offers a medical billing and coding specialist program. Students can choose between an associate’s of applied technology degree or a certificate program in medical billing and coding. This program is seeking accreditation through the Commission on Accreditation for Health Informatics and Information Management Education (CAHIIM) so future graduates can be eligible for RHIT certification.

The medical billing and coding program comprises five terms, each with 12-13 credits, totaling 62 units. The first term begins with basic concepts of anatomy and physiology, health care delivery and career exploration, medical terminology I, and computer application essentials. Credits and courses are found on the program map with detailed explanations and a visual graphic to display the direct correlation between each class.

The admissions process for the college begins with an online question asking what type of student the candidate may be. After selecting the most appropriate response, the interested party can follow the online resource list providing in-depth information through the online application process, mailing, faxing, or emailing necessary documentation of education history and completing the process online. Admissions to the medical billing and coding program require an individual application for the department.

• Location: Vancouver, WA
• Duration: One to two years
• Accreditation: Northwest Commission on Colleges and Universities  (NWCCU)
• Tuition: $123 per credit (residents); $311 per credit (non-residents)

Med Certs – Online medical coder & biller certification course

Med Certs – A Stride Company, offers an online medical coder and biller certification (MCBC) program that prepares students for a certification exam that can lead to an American Medical Certification Association (AMCA) credential. More specifically, the medical billing specialist program and the electronic health records and reimbursement specialist align with medical coder and biller-focused studies. 

Medical insurance specialists may work towards medical biller positions and later physician biller work after program completion, exam certification, and on-the-job training with extensive experience.

The electronic health records and reimbursement specialist’s position flow follows the same route as medical biller roles, intending to work in physician billing positions after certification and years of experience. For online medical billing, program certification will be in MCBC. The electronic health records and reimbursement specialist program certify students in CEHRS and MCBC. 

The MCBC program includes 14 weeks of coursework in professionalism in allied health, an introduction to human anatomy and medical terminology, insurance, and billing, and coding essentials. The CEHRS program consists of 19 weeks of study with the same courses as the MCBC program and an additional two courses, including Microsoft Office Basic and electronic health records. In addition, students learn to recognize ICD-10-CM, HCPCS, and CPT as well as modifiers, and, apply them to billing practices; understand payment differences, claims, and resubmission orders. 

The CEHRS program prepares students to understand the basics of human anatomy and the terminology of the medical field they will be working with; utilize CEHRS best practices; and understand the difference between ICD-10-CM, HCPCS, and CPT codes as well as file claims accurately. Students also learn how to comply with and identify HIPAA/HITECH, CMS, and other healthcare laws and regulations within the country. Lastly, the program covers the payment, claim, and submission or resubmission processes for easy filing. Both courses prepare individuals to sit for the AMCA exam for MCBC work. Preparation is critical for successful examination results, and Med Certs provide the necessary steps toward the goal. 

Admissions requirements include accessible internet access, course payment and registration completed and verified, and a high school diploma or GED verified. Med Certs set up the pathway for future career success with medical billing certification, electronic health records, and reimbursement specialist programs. 

• Location: Livonia, MI
• Duration: 12 weeks
• Accreditation: American Academy of Professional Coders (AAPC)
• Tuition: $2,000 total for the MCBC program; $4,000 total for the CEHRS program

Santa Barbara City College – Online medical coding specialist certificate

Prospective medical coding specialist positions require basic training to complete the exam by the American Health Information Management Association (AHIMA). The online medical coding certificate course at Santa Barbara City College meets the needs of those searching for a west coast-based option. Upon completing this program, graduates desiring to take the certified coding associate (CCA), certified professional coder (CPC), certified coding specialist-physician-based (CCS-P), or certified coding specialist (CCS) exam will be prepared. 

This program emphasizes the optimization of reimbursement, fee specifications, and insurance specifics, including diagnosis-related groups (DRGs); resource-based relative value scale (RBRVS); and ambulatory payment classifications (APCs). Other topics include in-patient and out-patient record maintenance; pharmacology terminology; knowledge of physiology shifts in the human body and disease processes; the impact of data quality and specifics. All coursework and exams are delivered online and students are expected to be fully engaged, self-motivated learners and manage their time effectively. 

The application for the spring semester opens in October and January for summer and fall courses. Before enrollment, applicants must verify a list of prerequisite courses through a transcript evaluation process, including coding, principles, and science.  

• Location: Santa Barbara, CA
• Duration: 1-2 years
• Accreditation: American Health Information Management Association (AHIMA)
• Tuition: $1,748 total (residents); $12,578 total (non-residents)

University of Cincinnati – Online medical coder certificate

The University of Cincinnati provides students with the necessary skills and knowledge for the certified professional coder (CPC) and certified coding associate (CCA) examinations. The program is completed entirely online for part-time or full-time enrolled students. 

The online self-paced curriculum includes courses in medical terminology for the health professional; foundations of pharmacology; introduction to anatomy and physiology lab; ICD medical coding I; health information ethics; ICD medical coding II; healthcare applications; CPT medical coding; and advanced coding applications. In addition, there are specific notations regarding computerized skills test options for transfer or opt-out credit based on prior work or test scores. Each course is outlined in detail on the curriculum link to the website. 

The admissions process for the course is open to individuals with a GED or high school diploma. The university requires transcripts, accepts the transfer of credits, and provides course credit for current credential holders. 

• Location: Cincinnati, OH
• Duration: One year
• Accreditation: Higher Learning Commission (HLC)
• Tuition: $3,619 per semester (full-time)

Franklin University – Online medical billing specialist certificate

Franklin University offers a fast-paced, online medical billing specialist certificate that students can earn in three to four months. Graduates from this program are eligible for the medical coder and biller certification (MCBC) exam authorized through the American Medical Certification Association (AMCA). This program is geared towards those with data entry expertise or interest who manage functions in a detailed fashion.

The program curriculum covers three primary subjects: professionalism in allied health, introduction to human anatomy and medical terminology, insurance, and billing and coding essentials. Franklin University and MedCerts work to meet modern students’ needs by providing college credit for the work completed in this program. Franklin courses described in the program are broken down into nine classes with individual credits earned for a degree option. 

Each course is self-paced and features a specific number of hours required. For example, allied health is deemed as 32 hours in length, anatomy and terminology take 96 hours, and billing and coding essentials also need 96 hours. In addition, the program boasts up-to-date computer graphics, interactive games, three-dimensional animations, virtual scenarios, and textbook-based learning to formulate a curriculum that supports all learners. 

Admissions to the program begin with creating an account with essential information and setting up a FranklinWorks Marketplace account. After those steps are completed, learning can start, and the pathway toward a future career takes off. 

• Location: Columbus, OH
• Duration: Three to four months
• Accreditation: Higher Learning Commission (HLC)
• Tuition: $2,000 total

University of Illinois Springfield – Online electronic health records certification

The University of Illinois Springfield offers a certified online health record specialist (CEHRS) program. This career pathway provides another layer of support in healthcare organizations and does not require prerequisite coursework to enroll. Courses include a direct overview of EHR and CEHRS, an introduction to the Harris care tracker system; an introduction to MOSS 3.0; history of EHRS; steps to EHRS implementation, HIPAA requirements, EHR and record content; treatment plans, lists, order, and results; coding and billing, patient communication; research, registries, reportable events, and practice reports; and personal health records and continuing care records. 

Admissions requirements to this program include a high school or GED. In addition, graduates from this program are prepared to take the CEHR exam.

• Location: Springfield, IL
• Duration: Six months
• Accreditation: Higher Learning Commission (HLC)
• Tuition: $1,975 total

It takes five to six years to become a certified medical coder and biller, beginning with high school or GED completion and earning a diploma, certificate, or associate’s degree.

Step 1: Graduate from High School or Complete a GED (Four Years)

Graduation from high school or completion of a GED is a requirement for the CPC exam. In high school, aspiring medical coders are encouraged to take business, sciences, and coding courses. 

Step 2: Become a Certified Medical Coder and Biller (Timelines Vary)

Becoming a certified medical coder and biller is most plausible when an individual completes a program of study that covers the necessary skills, knowledge, and experience for the position. Numerous certifications are available; for example, the American Academy of Professional Coders (AAPC) provides the national exam CPC after candidates finish a certified program.

Step 3: Gain Work Experience (One to Three Years Minimum)

Gaining work experience within the medical coder and biller field is necessary to move into other coder positions in which candidates need applied skill sets and knowledge only gleaned through experience. 

Step 4: Obtain National Certification for Specializations (Timelines Vary)

National certifications in medical coding and billing are possible through numerous certification organizations. Certifications are available at the entry-level and more experienced levels.

Completing an advanced program in coder and biller work supports an individual seeking to obtain national certification. After a handful of years working as a primary medical coder and biller, individuals are eligible for continued training and specialization work. See the section below on certification for more detailed information. 

Step 5: Maintain All Certifications (Every One to Five Years).

Professionals in the field who hold certification for a specific medical coder and biller area will need to renew their certification regularly. For example, CPC credential-holders must renew every two years and be able to show proof of earning 36 continuing education credits.

Medical coders and billers have specific job duties for every healthcare facility and hospital. The job duties of these professionals are as follows: 

• Code services
• Code procedures
• Code diagnoses and treatments
• Write and send invoices 
• Write claims for specific payments
• Correct readjusted claims
• Payment tracking
• Communicate with patients regarding billing and insurance claims
• Communicate with insurance companies about bills with balances due

Medical coder and biller certifications are not required to work legally, but they can help set individuals apart in a job search and provide quality assurance for employers. Certifications are available for specific health facilities and departments, and a handful of particular certificates are listed below. 

For example, the American Academy of Professional Coders (AAPC) features the following certifications for medical coders and billers:

• Medical coder and biller specialist certification (MCBS)
• Certified professional coder (CPC)
• Certified professional biller (CPB)
• Certified outpatient coder (COC)
• Certified inpatient coder (CIC)
• Certified risk adjustment coder (CRC)
• Certified professional medical auditor (CPMA)
• Certified experienced compliance officer (CPCO)
• Certified documentation expert outpatient (CDEO)
• Certified documentation expert inpatient (CDEI)
• Certified physician practice manager (CPPM)
• Ambulatory surgery center coder (CASCC)
• Certified Anesthesia and pain management coder (CANPC)
• Certified cardiology coder (CCC)
• Certified cardiovascular and thoracic surgery coder (CCVTC)

Certifications are valid for two years when completed at the national level—based on job requirements and organization regulations; individuals may need to renew their certificates every two years and show proof of 36 continuing education units.

According to the US Bureau of Labor Statistics (BLS May 2021), medical records specialists earned average annual salaries of $48,310. Salaries vary by experience and education, and the BLS shows the following salary percentiles: 

• 10th percentile: $29,130
• 25h percentile: $36,930
• 50th percentile (median): $51,840
• 75th percentile: $59,120
• 90th percentile: $105,690

There are career alternatives for medical coders and billers. Three examples of positions with similar qualifications are detailed below.

Become an Information Clerk

Information clerks provide organizational duties for a variety of companies and businesses. Some responsibilities include maintaining records, collecting data, clerical work, and providing customer information directly. 

• Typical Education: Associate’s degree
• Licensing or Certifying Organization: Unknown

Become a Medical Transcriptionist

A medical transcriptionist is required to listen to recordings of physicians and other providers or healthcare workers and transcribe the content. In addition, they are responsible for creating write-ups of the transcribed words. 

• Typical Education: Postsecondary non-degree award
• Licensing or Certifying Organization: Unknown

Become a Pharmacy Technician

A pharmacy technician’s primary duties are to support the pharmacist in distributing prescriptions. In addition, they work with pharmacists to serve public patrons and healthcare professionals. 

• Typical Education: High school diploma or equivalent
• Licensing or Certifying Organization: Pharmacy Technician Certification Board (PTCB) and National Healthcareer Association (NHA) are both certified by the National Commission for Certifying Agencies (NCCA)

Rachel Becker

Writer

Rachel Becker is a freelance writer who enjoys life in the PNW. She holds a master’s degree in education and taught in elementary classrooms for twelve years. When she is not running around after two toddlers, she makes time for daily movement, running two blogs, and reading.