Which process in healthcare billing system stays significant in the healthcare industry? How far does it take the business towards successful profits? Medical coding remains the crucial part of healthcare billing system though it connects the whole RCM process with accurate coding manners. Medical coders play a vital role, same as medical coding, as they take the responsibility of making the coding process accurate and better.

Medical records are moving online and medical billers need to ensure healthcare professionals are reimbursed timely and accurately. The number of healthcare jobs available in the United States is expected to grow by 18% within six years of time. Medical coding and billing is as important as patient responsibility to get maximum reimbursements. Do you want to learn more about the importance of medical insurance billing and coding in the healthcare industry and how you can become a medical coder?

What is Medical billing and coding in healthcare billing system?

  • Employees those who work for medical billing and coding departments in healthcare organizations indeed use technology to keep track of medical records and to obtain payment for any services that have been provided.
  • Medical coders in healthcare billing system are responsible to enter accurate codes for diagnosis that patients receive, any procedures that are completed on a patient, and enter special codes to keep a patient’s healthcare records updated.
  • The facilities where medical billing and coding specialists work include hospitals, rehabilitation centers, medical offices, and insurance companies.
  • The majority of the positions for a medical coding specialist are held within an office setting, with a mixture of both full-time and part-time positions available.

What does a Medical Coding specialist do in healthcare billing system?

  • As said, medical coding specialists play an important role in healthcare industry. Medical coding specialist is responsible for organizing complete data related to healthcare. They also need to ensure the data is accessible for medical professionals at a healthcare facility.
  • Medical coders spend the majority of their time working with electronic data. However, there are still some medical offices that use paper filing. The significant part of a medical coder’s work is to make sure that all of the coding and billing information is absolutely accurate.
  • Carrying the data that is accurate is necessary to ensure that patients are receiving the proper care and that insurance companies are able to swiftly process claims.
  • Additionally, in healthcare billing system, they need to ensure that the data they are processing is secure and confidential.
  • As patient confidentiality is legally required, medical billing and coding specialists have to learn and be aware of proper security measures. They need to ensure compliance with regulations for the protection of their patients.

Role of Medical Coder:

  • The medical coder reviews the patient’s file and translates everything from that file into universal codes required by insurance companies.
  • It’s the medical coder’s responsibility to ensure the right code is used every single time. It’s the only way to make sure the insurance companies are billed properly.
  • Whatever happens with the patient at the time of encounter is coded and filed. It includes everything from diagnosis and treatment, to what supplies were used.
  • Moreover, the medical coder also indicates if there were any unusual circumstances during the visit or procedure.
  • Medical coding is entirely different from medical billing. A medical biller does not perform the duties of a medical coder. A medical biller processes the insurance claims and follows up on them. They don’t determine what codes are used in the insurance billing.
  • But, a medical coder and a medical biller can be the same person if they have the experience and are given the proper training.
  • A medical coder has nothing to do with the technological aspects of medical record keeping.

Duties of Coding Specialist:

  • When you have a better understanding about medical coding and coder, take a closer look at the day-to-day responsibilities that a medical coder can be expected to complete.
  • Sometimes, these needs or requirements might vary based on the needs of a specific employer. Here is a list of some of the most common responsibilities that a medical coder can be expected to fulfill:
  1. Input and retrieve patient information into a computer system
  2. Keep data well organized, secure, and confidential
  3. Review medical data in an appropriate time frame and provide responses to inquiries from patients, practitioners and insurance companies
  4. Speak with care providers, insurers and patients to clarify medical records via the phone
  5. Enter correct codes when a patient receives a medical diagnosis so that medical professionals can administer the proper care. It is also essential for health statisticians to keep track of healthcare data, and to make sure that the proper information is submitted to insurance companies for reimbursement/payment.
  6. Act as a liaison (go-between) between insurance companies and medical facilities
  7. Input the proper codes into classification software so that patients can be reimbursed by insurance companies

Besides the educational requirements that a medical coder is required to have, there are other abilities that an individual should have to be successful on the job. Here are important qualities that you should have if you are considering working as a medical coder:

  1. Interpersonal abilities and quality communication skills, even if you are experiencing a high-stress situation such as a rejected insurance policy. Basically, you need to be nice, kind, and patient!
  2. Computer skills, such as being able to understand and use a spreadsheet, use medical coding software, classification programs, electronic health record programs, and other types of software. Most of the technology you’ll be using will be taught to you during your training program in school or on-the-job.
  3. Attention to detail, so that you are able to accurately input data. This means double-checking your work for accuracy.
  4. Decision-making capabilities, which will provide you with the ability to determine the best way to code medical information into the software. And if you are unsure, the confidence to ask a superior for clarification.


Keeping all these tasks in check, a medical coder should be ready to learn and gain knowledge on updated codes from various specialties without confusion. Outsourcing companies will have certified coders who can perform their job with no hassle.


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