What You Need To Know About Medical Insurance Billing and Office Administration

With the aging baby boomer population and more options available for health coverage, the healthcare industry as a whole is seeing increased demand for medical services and medical professionals. One career in particular that has a growing demand is medical billing and office administration. The U.S. Bureau of Labor Statistics (BLS) estimates that the job market for medical billers and office administrators will grow 22 percent by 2026. Medical billing is an excellent career option for people who are looking to go into medicine, but would prefer to work behind the scenes instead of working directly with patients.

Before going into any career, it’s important to be informed about any educational requirements, job duties, and projected outlook. Below, we covered some of the main points you should consider before delving into the field of medical billing and office administration.

What is Medical Billing/Coding and Office Administration?

Medical billers/coders and office administrators are the medical professionals that perform administrative tasks and keep the communication going between patients, physicians, and insurance companies. They are essentially the backbone of medical and healthcare facilities. Doctors and nurses are experts when dealing with patients, but when it comes to dealing with administrative office tasks, most of them aren’t trained for such duties. They are responsible for making sure that healthcare facilities are operating efficiently. They receive training in basic human anatomy, physiology, and disease processes associated with medical terminology. Some of the administrative tasks they perform include medical charting and filing, financial bookkeeping, processing insurance claims, etc. They also track and record patient data, manage coded information, communicate with medical staff to make sure they have the correct information, and assign ICD-10 codes for treatments and diagnoses.

Medical billers and administrators have a very broad skill set, so they can use their skills in many different settings. They can work in hospitals, clinics, and private offices. For the most part, they work independently, but they still report to a supervisor and manager. Additionally, they mainly work behind the scenes, but their work is equally as important because it is with their help that doctors and nurses are able to focus on treating patients.

The Difference Between Medical Billing and Coding

Medical billing and coding are two different functions, and each one has its own duties and tasks. Oftentimes jobs will combine billing and coding into a single position. This is especially the case for smaller organizations. Larger organizations, however, may divide the two roles into separate positions.

Medical Coders

Medical coders have the responsibility of taking a provider’s medical notes and converting them into the correct codes for their records and for bills. The codes are normally industry standard and they use certain combinations to identify the services being billed. They are primarily in charge of reviewing the patient’s file and translating everything from that file into universal codes that are required by insurance companies. They have to make sure to use the right code every time, so they normally start with CPT code books when translating doctor’s notes into useful medical notes.

Some of the most commonly used codes include the following:

  • Current Procedural Terminology (CPT) – These codes are used to identify specific procedures and examinations.
  • International Classification of Diseases (ICD-10) These codes are used for medical diagnoses. 
  • Healthcare Common Procedure Coding System (HCPCS) This includes codes that are not covered in the CPT and ICD-10, such as supplies and medical devices.

Some of the duties and tasks performed by medical coders include:

  • Assigning codes for reimbursements
  • Auditing clinical documentation
  • Following coding guidelines and conventions
  • Providing training to staff
  • Researching and analyzing data
  • Reviewing documentation that supports procedures and treatment results

Medical Billers

Medical billers are usually in sync with medical coders and their work goes hand in hand. They generate invoices and send claims to insurance providers. When bills go unpaid, it is normally the medical billing specialist who contacts the insurance companies to make sure all paperwork is taken care of. The billing process usually begins once a patient makes an appointment. Even though the coder primarily processes the codes, a medical biller still needs to understand the industry codes because they are in charge of reviewing the reasons why someone may get denied insurance claims.

Some of their duties include:

  • Updating patient information and managing patient payments
  • Working with insurance companies to file claims
  • Creating invoices using filing codes
  • Sending out invoices to patients
  • Taking care of denied claims

Some of the other requirements for the job may include the following:

  • Computer skills
  • Knowledge of how to use basic office equipment
  • Basic math skills 
  • Medical terminology

Medical Office Administrators

While medical billers/coders are responsible for ensuring the medical provider or practice compensates for their service, medical office administrators have slightly different duties and tasks. They are responsible for a medical office’s administrative tasks and they make sure that the office is running smoothly. Medical administrators bridge the gap between medical staff and patients. They are the ones who normally answer patient questions in regard to any procedures and any other questions patients might have.

Some of their duties include the following:

  • Bookkeeping
  • Filling out insurance forms
  • Laboratory services
  • Scheduling appointments
  • Answering telephones
  • Updating and filing patients’ medical records

Education Requirements

To enter this field, a high school diploma is needed; however, most employers usually require and prefer certification or the completion of an associate degree in medical billing and coding. The coursework to obtain a certification or a degree includes medical terminology, anatomy, and physiology. Students also have to become familiar with insurance providers, software applications, general laws and ethics like HIPAA and commonly used medical coding terms and procedures such as ICD-9 and certified medical transcription (CMT). The length of the training depends on the program, but for most places, it’s usually anywhere from a few months up to two years.

Working Conditions and Hours

Typically, medical administrators work full-time; however, they may need to work more than 40 hours per week, if required. Some may also be on call in the evenings and weekends in case of emergencies. The hours will mostly depend on the setting they work in. A medical administrator working in a hospital may need to work more hours than someone who is working in a 9 to 5 clinic. 

Certification

Although medical billing administrators are not always required to become certified, most employers and states do seek individuals who have earned their certification and are licensed. Being certified shows employers that you are qualified and you already have knowledge about the material. It also boosts confidence and it can help increase an individual’s prospects when seeking employment in the field. Individuals who go through a training program spend several months in the classroom, and they usually feel more prepared when entering the field for the first time.

Who Is a Good Fit for This Career?

Aspiring medical billers and coders should be comfortable working alone as the majority of their time will be spent behind a computer screen working with patient files. The job will also require excellent organizational skills. Many parts of the job are very tedious, so having a good organizational system down is key. You will save a lot of time and energy. In addition, having good communication skills is also really important as you will have to communicate with doctors, nurses, and other healthcare professionals.

Potential Careers

Once students graduate from their program, they can seek employment in positions such as Medical Biller and Coder, Medical Receptionist, Billing Clerk, Medical Secretary, Patient Account Representative, Patient Services Representative, etc. The most common employers of medical billing administrators are hospitals, clinics, and physicians’ offices.

Job Outlook

The outlook for medical billing and office administration roles is expected to rise. The U.S. Bureau of Labor Statistics (BLS) estimates that employment for medical billers and administrators is expected to grow 22 percent by 2026. This is much faster than the average for all occupations. Most doctors and nurses do not have a lot of training in the administrative side of running a business, so medical billers and coders are essential because they keep hospitals and clinics running while doctors can focus on providing care to patients.

As the country’s baby boom population will increase the need for elderly care, more jobs will become available in the years to come. Earning a certificate or completing an associate’s degree program can help you learn all of the necessary skills needed to pursue a rewarding career as a medical billing specialist or office administrator.   

Medical Assistant Program offered at these campus locations:
  • Huntsville
  • Quad Cities
  • Evansville
  • Fort Wayne
  • Granger
  • Kokomo
  • Lafayette
  • Muncie
  • Bowling Green
  • Erlanger
  • Hopkinsville
  • Owensboro
  • Ann Arbor
  • Battle Creek
  • Brighton
  • Canton (MI)
  • Davison
  • Flint
  • Grand Rapids
  • Kalamazoo
  • Kentwood
  • Lansing
  • Madison Heights
  • Midland
  • Muskegon
  • New Baltimore
  • Port Huron
  • Saginaw
  • Taylor
  • Cincinnati
  • Dayton
  • Elyria
  • Mansfield
  • Niles
  • Canton (OH)
  • Sylvania
  • Johnson City
  • Knoxville
  • Charleston
  • Morgantown
Dental Assistant Program offered at these campus locations:
  • Huntsville
  • Evansville
  • Fort Wayne
  • Granger
  • Kokomo
  • Lafayette
  • Muncie
  • Erlanger
  • Owensboro
  • Ann Arbor
  • Brighton
  • Canton (MI)
  • Davison
  • Flint
  • Grand Rapids
  • Kalamazoo
  • Kentwood
  • Lansing
  • Madison Heights
  • New Baltimore
  • Muskegon
  • Saginaw
  • Cincinnati
  • Dayton
  • Elyria
  • Niles
  • Johnson City
  • Knoxville
  • Charleston
  • Morgantown
Veterinary Assistant Program offered at these campus locations:
  • Huntsville
  • Erlanger
  • Canton
  • Kalamazoo
  • Madison Heights
  • New Baltimore
Pharmacy Technician Program offered at these campus locations:
  • Huntsville
  • Evansville
  • Fort Wayne
  • Granger
  • Muncie
  • Bowling Green
  • Brighton
  • Davison
  • Kalamazoo
  • Kentwood
  • Lansing
  • Madison Heights
  • Saginaw
  • Cincinnati
  • Mansfield
  • Johnson City
  • Charleston
Nursing Assistant Program offered at these campus locations:
  • Grand Rapids
  • Kalamazoo
  • Midland
Medical Insurance Billing & Office Administration Program offered at these campus locations:
  • Huntsville
  • Evansville
  • Fort Wayne
  • Granger
  • Kokomo
  • Lafayette
  • Muncie
  • Bowling Green
  • Erlanger
  • Owensboro
  • Ann Arbor
  • Brighton
  • Canton (MI)
  • Davison
  • Flint
  • Grand Rapids
  • Kalamazoo
  • Kentwood
  • Lansing
  • Madison Heights
  • New Baltimore
  • Port Huron
  • Muskegon
  • Saginaw
  • Taylor
  • Cincinnati
  • Dayton
  • Elyria
  • Niles
  • Mansfield
  • Johnson City
  • Knoxville
  • Charleston
  • Morgantown
Occupational Therapy Assistant Program offered at these campus locations:
  • Hopkinsville
  • Quad Cities
Nursing Program offered at these campus locations:
  • Canton (OH)
Practical Nursing Program offered at these campus locations:
  • Canton (OH)
Veterinary Technology Program offered at these campus locations:
  • Canton (OH)
Business Management Program offered at these campus locations:
  • Hopkinsville, KY
Medical Assistant Associate of Applied Science Degree online program
Health Care Administration Associate Degree online program
Human, Social, and Health Services Associate of Applied Science Degree online program
Medical Billing Administrative Specialist Associate Degree online program
Medical Office Administration Certificate Program online program