Interview with a Medical Coder & Biller

What is your job title and what industry do you work in? How many years of experience do you have in that field?
I am a medical biller and coder, the back end of the business of medicine. I started in direct patient care, but did not find interacting with sick patients to my liking. Having all the medical terminology and protocols down, I found my talents were better utilized in the back office.

When I tell people I am a medical biller, they say, “You send me bills.” That isn’t entirely true. By coding and submitting them correctly, I ensure their bills are appropriately paid by insurance or by government programs such as Medicare and Medicaid.

Would you describe the things you do on a typical day?
I read medical records and translate them into universally accepted, industry-standard code. The codes refer to medical procedures and diagnoses. The procedure code describes what service was provided to a patient. The diagnosis code identifies the medically necessary reason for which the procedure was performed.

On a scale of 1 to 10 how would you rate your job satisfaction? What would it take to unleash your full enthusiasm, talent and productivity?
What I do is a vital and necessary function. My job satisfaction easily rates 10 stars. I have been doing this for twenty years, so my enthusiasm is tempered by the fact that it is an ongoing challenge to constantly keep up with changing regulations and statutes. Health care is an industry governed by legislative mandates and contract law. It is a constant mental challenge, but one that is amply rewarded in professional respect and financial incentives.

What did you learn the hard way in this job and how did that happen?
When I entered the medical billing field twenty years ago, people were handed code books and told to get to work without any formal training. Nowadays, there are certifications and structured scholastic programs offered at community colleges. While I have a background in direct patient care, I had no training in billing or coding when I started. Luckily, it is not rocket science.

What don’t they teach in school that would’ve been helpful to you?
Medicine is a broad field with many specialties. While a grounding in the basics of billing and coding will carry a person far, each medical specialty has its own rules and guidelines on how services should be coded and submitted for reimbursement. Practice in the field is necessary after the basics are mastered.

How did you get started in this line of work? If you could go back and do it differently, what would you change?
I enjoy the abstraction and pure theory that dictates much of medical coding and billing, as well as compliance with government and insurance regulations. Every day brings the discovery of a new wrinkle in the reimbursement process. I stumbled into this field because I already had the basic skills to do it. The only way to really master it, is to roll up your sleeves and get your hand dirty in the charts and the code books. It is a forgiving discipline, and there is ample opportunity to learn as you go.

What’s the strangest thing that ever happened to you in this job?
While a physician and a patient may think a procedure is medically necessary, insurance policies may differ on that view. Medicare only covers procedures that treat active disease processes. CMS has made some exceptions to cover preventative care and screenings in recent years. My job is make sure that what is documented in the patient chart meets the medical necessity requirements to guarantee coverage. There isn’t a lot of wiggle room. No matter what the physician thinks, some procedures are considered medically necessary only for certain conditions. While the patient may benefit from a procedure, it may not be covered no matter the result.

On a good day when things are going well, can you give an example of something that really makes you feel good?
My role is two-fold. I work to make sure a medical practice receives the maximum allowable, legal reimbursement for provided services. When I can collect a lot of money for a medically justifiable service, it pleases me that we can continue in business. When a patient finds a discrepancy in his or her bill, it pleases me to deal directly with their insurance company to correct their records and spare the patient a large out-of-pocket expense. My job is not to stick a big bill on sick people. It is to make sure the parties responsible for paying for medical care do so as they promise to, in a timely manner.

When nothing seems to go right, what kind of snafus do you handle and what do you dislike the most?
A medical biller spends a lot of time dealing with insurance companies on the phone. If you have ever called an insurance company, you know this means navigating pre-programmed menus and many minutes on hold. This time is spent balancing accounts, posting payments, writing off contractual obligations, and reading current literature about trends in coding methodology and protocols. There are few dull minutes for someone interested in this profession and engaged in keeping on top of the game.

Perhaps you wanted something more dramatic than the story of a medical biller and coder. I cannot provide spicy anecdotes, and that is an occupational hazard I have learned to live with. I am not an trauma surgeon nor an EMT.

How stressful is your job? Are you able to maintain a comfortable or healthy work-life balance?
There is very little stress involved in typing most of the day. I deal with numbers and abstractions most of the time. I read medical records, which reveal quite a bit of interesting knowledge, all of it confidential. Over time, the particulars of a given case become less interesting in that a patient’s identity is never a consideration, only the disease process and its subsequent treatment.

I have a curious mind, and typing most of the day while dealing in codes is an enjoyable way to spend the day. What I do is abstract, and people looking to enter the field should know that. It is not for everyone, as I think I’ve made clear, but it is is a rewarding career.

What’s a rough salary range for the position you hold? Are you paid enough and/or happy living within your means?
Salaries depend on region and the amount of expertise. Medical billing and coding have been very good to me. I have earned quite generous salaries that border on being embarrassing. I have always been able to maintain a comfortable lifestyle no matter what position I held in the field.

It can range from $30,000 a year, which I would consider chump change, to over $100,000 a year which would be very nice. I don’t see any point in raising or dashing anyone’s expectations with hard numbers, only encourage them with vague, direct experience. I could quote my Boston-based salary, but it would be meaningless to someone living in rural Montana.

 What’s the most rewarding moment you’ve experienced in this position? Of all the things you’ve done at work, what are you most proud of?
I keep medical businesses afloat and I increase profits legally by accurately reporting appropriate medical services to third party payers. I enable patients to take full advantage of their medical benefits.

What’s the most challenging moment you’ve experienced? What would you prefer to forget?
Every day offers its own administrative challenges in an atmosphere of ever-changing requirements. There is nothing that cannot be rectified, however, with proper documentation and correction.

What education and skills do you need to get hired and succeed in this field?
Some accounting background is helpful, but an understanding of medical terminology and practice goes much farther in understanding medical coding and medical reimbursement. It can be learned on the job, but most employers now require some kind of prior formal training.

What would you tell a friend considering your line of work?
A medical biller and coder is a respected member of the health care team. It is, however, a discipline which many people find dull and confusing. Attention to detail and an appreciation for abstraction are key requirements for success.

How much vacation do you take? Is it enough?
I take a month off on average. I have a very flexible schedule since the presence of patients is not required for what I do.

Are there any common misunderstandings you want to correct about what you do?
A medical biller’s and coder’s role is to make sure services are accurately described so that patients do not receive oversized bills.

If this job moves your heart – how so? Feel like you found your calling or sweet spot in life? If not, what might do it for you?
It is hard to be passionate about being a specialized bookkeeper, but I take great pride in my profession. I have yet to find a biller or coder who feels otherwise.

If you could write your own ticket, what would you like to be doing in five years?
I am already performing a rewarding service in both the professional and the personal sense. I expect I will be doing the same for the rest of my working life.

Is there anything unique about your situation that readers should know when considering your experiences or accomplishments?
Starting at entry level will be very frustrating. There is a lot of material to master and many, many regulations that govern this profession. The upside is few people want to master the discipline, so they leave it to medical billers and coders as trusted specialists to advise and produce with little interference.