Medical Billing and Coding Specialist Job Description [Updated for 2025]

In the era of advanced healthcare systems, the demand for Medical Billing and Coding Specialists has never been more critical.

As healthcare practices continue to evolve, the need for skilled individuals who can seamlessly manage medical coding and billing processes grows stronger.

But let’s delve deeper: What’s truly expected from a Medical Billing and Coding Specialist?

Whether you are:

• A job seeker trying to understand the core of this role,
• A hiring manager outlining the ideal candidate,
• Or simply curious about the intricacies of medical billing and coding,

You’ve landed at the right spot.

Today, we present a customizable Medical Billing and Coding Specialist job description template, designed for easy posting on job boards or career sites.

Let’s dive right in.

Medical Billing and Coding Specialist Duties and Responsibilities

Medical Billing and Coding Specialists play a crucial role in the healthcare industry.

They ensure that healthcare providers are accurately reimbursed for the services they provide, and they help to streamline the healthcare reimbursement process.

Their primary duties and responsibilities include:

• Review patient medical records and assign codes to diagnoses and procedures performed
• Ensure that the assigned codes meet all federal, legal, and insurance regulations
• Enter coding information into electronic health record (EHR) systems
• Submit claims to insurance companies for reimbursement
• Follow up on unpaid claims and denials to determine reasons for non-payment
• Address and resolve any billing and coding issues with healthcare providers, insurance companies, and patients
• Maintain confidentiality of patient information following HIPAA guidelines
• Stay up-to-date with changes in medical terminology and insurance practices
• Perform regular audits to ensure accuracy in billing and coding
• Conduct training sessions for staff on correct coding and billing procedures

 

Medical Billing and Coding Specialist Job Description Template

Job Brief

We are seeking a detail-oriented and reliable Medical Billing and Coding Specialist to join our healthcare team.

Your responsibilities will include recording and processing patient data including treatment records, insurance information, and payment plans.

The ideal candidate will have a strong understanding of anatomy and medical terminology and be well-versed in the latest medical coding procedures and regulations.

 

Responsibilities

• Translate patient information and into alphanumeric medical code
• Collect, post, and manage patient account payments
• Submit claims to insurance
• Process payments from insurance companies
• Maintain strict confidentiality
• Code patient services and enter into computer
• Sort and handle paperwork
• Resolve inconsistencies, denials/rejections of claims
• Ensure all codes are current and active
• Report findings and actions to the billing supervisor

 

Qualifications

• Proven experience as a Medical Billing and Coding Specialist
• Good knowledge of medical coding information
• Understanding of medical procedures, and diagnosis
• Working knowledge of billing software and electronic medical records
• Strong data entry skills along with a knack for numbers
• High school degree or equivalent; further education in medical billing or coding will be appreciated
• Certification in medical coding (e.g. CPC) is a plus

 

Benefits

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

 

Additional Information

• Job Title: Medical Billing and Coding Specialist
• Work Environment: Medical office setting. Monday to Friday, full-time hours with potential for occasional weekend and evening shifts.
• Reporting Structure: Reports to the Billing Supervisor or Practice Manager.
• Salary: Salary is dependent on candidate’s experience and qualifications, and in line with market rates and company budget.
• Pay Range: $45,000 minimum to $75,000 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 Billing and Coding Specialist Do?

Medical Billing and Coding Specialists are integral members of healthcare administration teams.

They are typically employed by hospitals, clinics, physician’s offices, nursing homes, or insurance companies.

Their main responsibility is to translate healthcare services into medical billing codes, which are then used for billing patients and insurance companies.

They review patient records and apply appropriate codes for diagnosis and treatment procedures.

Additionally, they also handle billing process, preparing and sending invoices or claims for payment to patients and insurance providers.

They check insurance claim procedures and ensure that they are correctly processed and paid.

Medical Billing and Coding Specialists may also be involved in addressing billing-related queries from patients and resolving any discrepancies or errors.

They communicate with healthcare providers and insurance companies on a regular basis to discuss updates or changes in the billing process.

These specialists need to be proficient in using medical coding systems and stay updated on changes in medical terminology and insurance policies.

They are expected to maintain patient confidentiality and comply with all legal requirements in handling patient information.

Lastly, they provide reports to management, detailing billing activity, insurance reimbursement, and collection rates.

This role is essential in maintaining the financial health of healthcare institutions.

 

Medical Billing and Coding Specialist Qualifications and Skills

A proficient Medical Billing and Coding Specialist should possess the qualifications and skills that align with your job description, such as:

• Knowledge of medical terminology, anatomy, and physiology to accurately code the services and diagnoses.
• Proficiency in medical coding systems such as ICD and CPT to facilitate accurate billing and record keeping.
• Attention to detail to ensure accurate input of codes and data, reducing the possibility of insurance claim rejections.
• Strong organizational skills to manage large amounts of data and maintain patient records meticulously.
• Ability to interpret and follow complex medical billing and coding guidelines.
• Good communication skills to liaise with healthcare providers, insurance companies, and patients on billing issues.
• Problem-solving skills to resolve discrepancies in medical bills and insurance claims.
• Computer skills, including proficiency in medical billing and coding software, Electronic Health Record (EHR) systems, and Microsoft Office Suite.
• Understanding of healthcare privacy and confidentiality laws, such as HIPAA, to ensure patient information is secured.

 

Medical Billing and Coding Specialist Experience Requirements

Entry-level Medical Billing and Coding Specialists are typically required to have completed an accredited certificate or associate degree program in medical billing and coding.

These programs offer students practical knowledge in medical terminology, health data standards, and software applications.

Many programs also offer externships, providing students with valuable experience in real-world medical billing and coding settings.

Even though they are entry-level, they may have a year or so of experience, often through these externships or part-time roles in a healthcare facility.

Candidates with about 2-3 years of experience are usually proficient in the use of medical software and have a good understanding of medical terminologies and insurance procedures.

They may have gained their experience through positions like Medical Records Clerk, Billing Coordinator, or similar roles in the healthcare industry.

Those with more than 5 years of experience are often well-versed in current coding standards and billing procedures.

They are typically adept at handling complex billing issues and have honed their skills in resolving insurance-related concerns.

This level of experience may also include some supervisory or team lead responsibilities, indicating their readiness for managerial roles in the medical billing and coding field.

Moreover, professionals with long-term experience are expected to maintain their credentials through continuous education as regulations and technologies change frequently in this field.

 

Medical Billing and Coding Specialist Education and Training Requirements

Medical Billing and Coding Specialists generally need to have a high school diploma or equivalent education as a starting point.

The next step is to enroll in a program dedicated to medical billing and coding, which is often provided by community colleges, vocational schools, and some universities.

These programs can lead to a diploma, certificate, or associate’s degree, depending on the level of the program.

In these programs, students are educated on medical terminology, anatomy, health data requirements and standards, classification and coding systems, healthcare reimbursement methods, and medical record types.

Upon completion of the program, graduates are encouraged to become certified.

There are a number of agencies that offer certification in medical billing and coding, such as the American Academy of Professional Coders (AAPC) and the American Health Information Management Association (AHIMA).

Certification typically requires passing an exam and may need to be renewed periodically by earning continuing education credits.

While not always required, certification can help increase job prospects and potential salary.

It also demonstrates a candidate’s commitment to professionalism, adherence to standards, and continuous learning in this rapidly evolving field.

Some employers may prefer candidates with prior experience in a healthcare setting, though many entry-level positions are available that provide on-the-job training.

Having knowledge of medical software and computer systems is also beneficial for this role.

 

Medical Billing and Coding Specialist Salary Expectations

The average salary for a Medical Billing and Coding Specialist is $40,350 (USD) per year.

However, the actual earnings may vary depending on the level of experience, certification, geographical location, and the employing healthcare institution.

 

Medical Billing and Coding Specialist Job Description FAQs

What skills does a Medical Billing and Coding Specialist need?

Medical Billing and Coding Specialists should have strong attention to detail and organizational skills as they need to manage a wide array of billing codes and patient records.

They should also possess good communication skills for interacting with healthcare providers and insurance companies.

A good understanding of medical terminology, anatomy and coding systems like ICD is crucial.

 

Do Medical Billing and Coding Specialists need a degree?

While a degree may not be strictly necessary, Medical Billing and Coding Specialists typically require a certificate or associate’s degree in medical billing and coding.

Some employers prefer candidates with a professional certification such as Certified Professional Coder (CPC) or Certified Coding Specialist (CCS).

 

What should you look for in a Medical Billing and Coding Specialist resume?

A good resume should show the candidate’s knowledge of medical billing and coding processes, insurance claims, and healthcare software.

It should also mention any relevant certifications.

Any experience in a healthcare setting and familiarity with electronic health records (EHRs) can be a significant plus.

 

What qualities make a good Medical Billing and Coding Specialist?

A good Medical Billing and Coding Specialist is detail-oriented, ensuring that all coding and billing information is accurate to avoid any issues with insurance claims.

They also need to be organized, able to manage a large number of patient records and billing information.

Good interpersonal and communication skills are also necessary for liaising between healthcare providers and insurance companies.

 

Is it challenging to hire Medical Billing and Coding Specialists?

Hiring a Medical Billing and Coding Specialist can be challenging due to the specialized nature of the job.

The candidate needs specific education and training in medical billing and coding, and ideally, they should have relevant experience in the field.

Therefore, it’s important to assess their training and credentials carefully during the hiring process.

 

Conclusion

And there we have it.

Today, we’ve shed light on what it truly means to be a Medical Billing and Coding Specialist.

Surprised?

It’s not just about managing numbers and data.

It’s about orchestrating the financial health of the medical world, one bill, and one code at a time.

With our comprehensive Medical Billing and Coding Specialist job description template and real-life examples, you’re ready to take your next step.

But why pause here?

Delve further with our job description generator. It’s your essential resource to produce precision-crafted job listings or fine-tune your resume to perfection.

Remember:

Every medical bill and code is a crucial piece of a larger healthcare puzzle.

Let’s solve that puzzle. Together.

How to Become a Medical Billing and Coding Specialist (Complete Guide)

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