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What Is A Medical Coding And Billing Specialist? 

Mar 15

If you want to work in the field of the healthcare industry, getting in the field of medical billing and coding is the perfect option for you. Medical coding and billing specialists are the people who work behind the curtains to connect the medical service provider and the payers or the insurers. This is why medical billers and coders are also required even by the best medical billing company in the USA. In addition, these professionals require less education than other medical professionals. Still, these professionals are very important for the medical practice's success. If you are looking for medical billing and medical coding services, then UControl Billing is one of the best providers you can contact! 

Difference between Medical Coding and Billing

To discuss medical claims and billing specialist, let us first discuss what medical billing is and what medical coding is. Here are the definitions that will help you to understand:  

Medical Billing

The process of medical billing includes the generation and submission of medical claims to the payers and insurers to get paid for the services that the medical practitioner or the medical practice has provided to the patient. 

Medical Coding

The process of medical coding focuses more on the patients' medical records. This involves transcribing the information into codes so that misleading notes or diagnoses can be prevented and claims can be successfully submitted. 

Both processes are very important, and therefore most practices look for the best medical billing company to get the best services! 

What Is a Medical Coding and Billing Specialist?

Now that you know what medical billing and coding are? Let us move to the medical coding and billing specialist. Medical coders and medical billers are the specialists who function as a medium of communication between the medical practice and the insurance company. This implies that medical coders and billers assist the medical practice in managing insurance claims, payments, and invoices. Here is what most medical billers and coders do while providing the best medical coding services: 

  • Properly transcribing the provided services, procedures, diagnoses, and treatments into codes. 
  • Generating the invoices and claims 
  • Submitting invoices or claims to get reimbursed
  • Correcting rejected claims
  • Keep tracking the payments
  • Following up on medical bills and claims

The medical billing and coding specialist can work in a medical practice where the patient gets treated or work in the best medical billing company. This is because this sort of work does not require facing the patients, and on the contrary, it is an office-based job. This also implies that to provide medical coding services, the medical coders and billers have to spend a lot of time working on computers for reviewing, entering, and updating information.

Comparing medical coding and medical billing specialists

There is a lot of overlapping regarding the duties and qualifications of medical coders and medical billers. In addition, both are equally important for one another. Still, despite having similar properties, there are also some important differences between the two. By knowing the differences, you can decide which path or which profession suits your skills and goals. Here we have gatherers some factors that can distinguish between the two services: 

Education and training

In order to provide medical billing and medical coding services, getting a diploma or GED is required. Some of the best medical billing companies also require the applicant to have an associate degree or certificate in finance or medical billing. Yet it won't be difficult to find a medical billing company that prefers experience over education for this particular position. 

To become a medical coder, one often has to have an associate degree in medical coding and billing. This is because, for coding, one must know medical terminologies and special coding sets. The good thing is that both medical billers and coders can get training on software programs that the medical facilities use to streamline their medical coding and billing. 


In addition to the certificates that can be earned via college-based programs, medical billers and coders can receive certification from private organizations to provide medical billing and coding services. These certificates prove that the applicant has comprehension and competence in the field of work. In addition, such certificates also increase the chances of the applicant being selected for the job. 

To increase the chances of working in the best medical billing company, a medical biller can get a Certified Professional Biller (CPB) certificate from the American Academy of Professional Coders (AAPC). In addition to that certificate, (AAPC) also provides Certified Billing and Coding Specialist (CBCS) certificates for professionals who want to work in both positions. 

In comparison to medical billers, medical coders have many opportunities and certifications. This is because their career involves specializations in different practices. Here are some of the certificates that can be obtained from AAPC: 

  • Certified Risk Adjustment Coder (CRC)
  • Certified Professional Coder (CPC)
  • Certified Outpatient Coder (COC)
  • Certified Inpatient Coder (CIC)

Job duties and skills

It is known that medical billers and medical coders have different duties and different medical billing and medical coding services. Still, some issues require both specialists to work together to handle communication with the insurance companies.  

Both medical billers and coders have to pay proper attention to the details, and also both specialists should have good mathematical skills while maintaining the confidentiality of the patients. The difference between the two is that medical coders can work independently, whereas medical billing specialists have to work directly with patients and insurers to get payments. 

What does the Medical Coder do? 

Medical coders have to take practitioners' diagnostic and procedural data and then translate them into codes to keep records and provide proper billing. The codes that the coders have to abide by are industry-standard alphanumeric combinations that help in identifying services that are provided and should be billed. Here are different codes that medical coders use: 

  • Current Procedural Terminology (CPT)
  • International Classification of Diseases (ICD-10)
  • Healthcare Common Procedure Coding System (HCPCS) 

Insurance billing uses the codes mentioned above, which is for the best medical coding services. The coders must follow the guidelines and use the proper software. 

What does the Medical Biller do? 

As soon as the coding process ends, the billing process starts, and the medical billers have to generate invoices and then send the claims to the insurance companies. The insurer approves, denies, or rejects a claim based on the coding. 

The medical billing process starts at the very moment when the patient books an appointment with the practitioner because the code has to be entered and submitted to the insurer to get pre-approval. Doing so can determine the out-of-pocket costs that the patient has to pay, and the medical practice can get it from them when they first visit the practice.

In addition to their duties, medical billers must know the industry codes. This is important because medical billers have to audit the reasons that caused claim denials, and also, they might have to update them before submitting the claim. Here are some other duties that are performed by medical billers: 

  • Invoicing the remaining billing to the patients
  • determine co-pay requirements
  • track the payments
  • Follow up on outstanding payments
  • Contact insurance companies if the bill goes unpaid
  • Turn the debt to a collection agency if the patient fails to pay

We are wrapping up! 

The article has explained well who medical billers and coders are. If you are looking for medical coders and medical billers for your practice's billing and coding process, try outsourcing medical billing and medical coding services from billing companies. UControl Billing is the best medical billing company that provides affordable services with the help of the best medical billing and coding specialist! To know more about them, visit their website.