Medical Biller and Coder Job Description [Updated for 2025]

In the realm of healthcare, the role of medical billers and coders is crucial.

As healthcare evolves, the demand for skilled individuals capable of managing, interpreting, and processing medical codes and billing grows.

But let’s delve deeper: What’s truly expected from a medical biller and coder?

Whether you are:

A job seeker looking to understand the core of this role,
A hiring manager defining the perfect candidate,
Or simply curious about the ins and outs of medical billing and coding,

You’re at the right place.

Today, we present a customizable medical biller and coder job description template, designed for easy posting on job boards or career sites.

Let’s dive in.

Contents show

Medical Biller and Coder Duties and Responsibilities

Medical Billers and Coders manage patient records and translate healthcare services into medical billing codes.

They play a crucial role in the healthcare revenue cycle management process to help healthcare providers get paid for their services.

Their responsibilities include but are not limited to:

Reviewing patient records and doctor’s notes to accurately identify services provided
Translating healthcare services into appropriate diagnostic and procedure codes (ICD-10, CPT, HCPCS)
Submitting claims to insurance companies and following up to ensure they are processed correctly
Working with healthcare providers and insurance companies to resolve any discrepancies in payment
Maintaining strict confidentiality of patient information in line with HIPAA requirements
Reviewing and appealing unpaid and denied claims
Verifying patient insurance coverage and eligibility
Keeping up-to-date with changes in medical coding and billing regulations and practices
Performing periodic audits to ensure accurate billing and coding practices

Medical Biller and Coder Job Description Template

Job Brief

We are seeking a meticulous and dedicated Medical Biller and Coder to join our healthcare team.

Your primary responsibility will be to review the patient’s records and assign appropriate medical codes for each diagnosis and treatment.

Medical Biller and Coder responsibilities include maintaining and updating patient records, ensuring accurate coding for medical services, and handling insurance claims and disputes.

Our ideal candidate will have a comprehensive understanding of medical terminology, coding, and billing guidelines.

Responsibilities

Review medical procedures as documented by physicians
Translate medical procedures into codes that can be translated by payers, other medical coders, and other healthcare facilities
Submit claims to insurance companies
Ensure claims are processed and paid by contacting insurance companies and patients
Update billing software with rate changes
Processes payments from insurance companies and prepares a report on collections
Maintain patient confidentiality and information security
Follow up on unpaid claims within the standard billing cycle timeframe

Qualifications

Proven work experience as a Medical Biller or similar role
Knowledge of insurance guidelines including HMO/PPO, Medicare, Medicaid, and other payer requirements and systems
Experience in coding information system applications
Working knowledge of medical jargon and anatomy preferred
Ability to multi-task and meet deadlines
High School Diploma or equivalent
Certification in medical coding (e.g., CPC or CCS-P) is a plus

Benefits

401(k)
Health insurance
Dental insurance
Retirement plan
Paid time off
Professional development opportunities

Additional Information

Job Title: Medical Biller and Coder
Work Environment: This role is typically office-based in a healthcare setting. It usually involves periods of sitting and computer use, with some potential for patient interaction.
Reporting Structure: This role typically reports to the Billing or Practice Manager.
Salary: Salary is based upon candidate experience and qualifications, as well as market and business considerations.
Pay Range: $40,000 minimum to $60,000 maximum
Location: [City, State] (specify the location or indicate if remote)
Employment Type: Full-time
Equal Opportunity Statement: We are an equal opportunity employer and value diversity at our company. We do not discriminate on the basis of race, religion, color, national origin, gender, sexual orientation, age, marital status, veteran status, or disability status.
Application Instructions: Please submit your resume and a cover letter outlining your qualifications and experience to [email address or application portal].

What Does a Medical Biller and Coder Do?

Medical Billers and Coders are key players in the healthcare sector who primarily deal with the financial and administrative aspects of healthcare services.

They are responsible for translating healthcare services into medical codes for billing purposes.

This includes procedures, diagnoses, and medical equipment used during patient care.

Their work involves reviewing patient records and using specific classification systems to code and categorize patient information for insurance reimbursement, databases, and to maintain patient medical histories.

Medical Billers, specifically, prepare billing invoices for services rendered, verify insurance benefits, submit claims to insurance companies, and follow up on unpaid claims.

They might also need to resolve any discrepancies or errors found in the claims by working closely with healthcare providers and insurance companies.

On the other hand, Medical Coders assign appropriate codes for each patient’s diagnosis and treatment.

They need to have an in-depth understanding of the coding systems and medical terminologies to accurately document patient data.

Besides, these professionals also ensure compliance with medical coding policies and guidelines to meet regulatory requirements.

They play a crucial role in ensuring the smooth operation of healthcare facilities and maintaining the financial health of the healthcare system.

Medical Biller and Coder Qualifications and Skills

Medical Billers and Coders should possess a combination of technical skills and soft skills, along with a strong understanding of medical terminology and healthcare industry.

These include:

Thorough knowledge of medical terminology, coding, and billing processes to accurately translate patient information, diagnosis, and treatment details into codes for billing purposes.
Proficiency in using various coding systems such as ICD (International Classification of Diseases), CPT (Current Procedural Terminology), and HCPCS (Healthcare Common Procedure Coding System).
Strong attention to detail to ensure all codes are correct and billing information is accurately recorded and processed.
Exceptional organizational skills to manage a large volume of patient records and billing information.
Strong communication skills to effectively interact with healthcare providers, insurance companies, and patients about billing and coding issues.
Understanding of healthcare regulations and compliance standards to ensure all coding and billing practices adhere to legal and ethical guidelines.
Problem-solving skills to identify and resolve discrepancies in medical codes and billing data.
Computer literacy and familiarity with electronic health records (EHR) software and medical billing software.

Medical Biller and Coder Experience Requirements

Medical Billers and Coders typically need to have a certain level of education and professional experience to be competitive in the job market.

At the entry level, candidates usually have a minimum of an associate degree in Health Information Management or a related field.

They may also have completed a certification program in medical billing and coding.

Some practical experience can be gained through internships or part-time roles in healthcare settings.

These experiences provide a solid foundation in medical terminology, health data requirements, and coding systems.

Candidates with 1 to 2 years of experience often hold positions in medical offices, clinics, or hospitals where they gained hands-on experience in processing medical bills and coding medical procedures.

Those with more than 3 years of experience often have a deeper understanding of complex coding systems, healthcare regulations, and insurance processes.

They may have also developed skills in auditing and compliance, making them eligible for more specialized or senior roles in the field.

Candidates with more than 5 years of experience often have extensive knowledge of medical billing and coding procedures, healthcare regulations, and medical software.

They may have also honed their skills in data analysis and accuracy.

At this level, they may qualify for supervisory or managerial roles within a medical billing and coding department.

Medical Biller and Coder Education and Training Requirements

Medical Billers and Coders typically need to have a high school diploma or equivalent.

They usually complete a certificate or an associate’s degree program in medical billing and coding.

These programs cover subjects such as medical terminology, health data requirements and standards, classification and coding systems, healthcare reimbursement methods, and computer systems.

Certification is not always a strict requirement, but it is highly recommended.

Medical Billers and Coders can earn certification through several organizations, including the American Academy of Professional Coders (AAPC) and the American Health Information Management Association (AHIMA).

The certification process usually requires passing an exam.

In addition, some employers may prefer candidates with prior work experience in a healthcare setting, although this is not a strict requirement.

Continuing education is important in this field due to changes in laws and regulations.

Therefore, ongoing training and education are essential for maintaining current knowledge and skills.

Knowledge of medical software, as well as strong attention to detail and analytical skills, are also important for Medical Billers and Coders.

Medical Biller and Coder Salary Expectations

A Medical Biller and Coder earns an average salary of $42,630 (USD) per year.

The actual earnings can vary based on factors like experience, certification, geographical location, and the healthcare facility they work for.

Medical Biller and Coder Job Description FAQs

What skills does a Medical Biller and Coder need?

Medical Billers and Coders should have strong analytical skills to translate medical records into codes accurately.

They also need excellent attention to detail to ensure the accuracy of the coding and billing process.

Good knowledge of medical terminology, anatomy, and healthcare procedures is crucial.

Additionally, they should have strong organizational skills to manage a large number of patient records and bills.

Do Medical Billers and Coders need a degree?

While a degree is not always required, many employers prefer candidates with an associate’s degree or a certificate in medical coding and billing.

This is a highly specialized field, and formal education can provide a strong foundation in medical terminology, health records management, and insurance procedures.

Some professionals may also choose to pursue certification through organizations such as the American Academy of Professional Coders (AAPC).

What should you look for in a Medical Biller and Coder resume?

On a Medical Biller and Coder’s resume, you should look for a solid educational background in medical coding and billing.

Check if they possess any industry-specific certifications, such as CPC (Certified Professional Coder), CCA (Certified Coding Associate), or CCS (Certified Coding Specialist).

Also, look for experience with medical software systems and any experience in healthcare settings.

Key skills to look out for include medical coding, medical billing, health information management, and proficiency in ICD-10 codes.

What qualities make a good Medical Biller and Coder?

A good Medical Biller and Coder is detail-oriented and accurate as the job requires dealing with complex medical information and coding systems.

They should have strong ethical standards to handle sensitive patient information with confidentiality.

Good communication skills are also essential to interact with healthcare providers, insurance companies, and patients.

They should also be able to work under pressure and meet deadlines as billing and coding affect the revenue cycle of healthcare providers.

Is it difficult to hire a Medical Biller and Coder?

Hiring a Medical Biller and Coder can be challenging due to the specialized skills and knowledge required for the role.

Moreover, the demand for these professionals is high in the healthcare industry.

To attract competent candidates, employers often offer competitive compensation, opportunities for professional development, and a conducive work environment.

Conclusion

And there you have it.

Today, we’ve demystified what it truly means to be a Medical Biller and Coder.

And guess what?

It’s not just about processing payments and coding claims.

It’s about shaping the future of healthcare, one billing and coding task at a time.

With our indispensable Medical Biller and Coder job description template and real-world examples, you’re equipped to take the next step.

But why stop there?

Immerse yourself further with our job description generator. It’s your gateway to crafting precise listings or refining your resume to excellence.

Remember:

Every invoice and medical code is a part of the larger healthcare system.

Let’s shape the future of healthcare. Together.

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Medical Biller and Coder Job Description [Updated for 2025]

Medical Biller and Coder Duties and Responsibilities