Leveling Up: How to Build Medical Billing & Coding Skills

The Information Age has transformed the workforce by creating many jobs in which the primary responsibility is collecting, reviewing, analyzing, disseminating, securing, and retaining some form of valued information. The healthcare industry is one of many sectors affected by the technological transformation characteristic of this new era. A skilled workforce that can nimbly work with information within the immense variety of healthcare sector settings will continue to be in demand for the foreseeable future.

American healthcare is a high-volume industry. Americans make hundreds of millions of visits to physician offices each year. This large volume of activity requires a workforce that can effectively gather, analyze, code, troubleshoot, transmit, and retain such information for multiple purposes. One such purpose is billing. A medical coder conducts data entry and other tasks to create payment records and patient bills, subsequently billing insurance companies for services rendered.

Professionals seeking to work in the medical coding and billing profession can enter the industry through several pathways. These pathways include an associate degree in medical coding, a certificate from an accredited organization, or on-the-job training from a current employer. These pathways each have distinct pros and cons. Given the size, complexity and needs of the healthcare system, medical coding and billing professionals can expect to find ample opportunity to pursue a rewarding career.

Continue reading for information about the benefits of this path and how to get started.

Like many industries, healthcare sector operations have become increasingly computerized in the last several decades. The use of advanced technology for medical records evolved due to the significant advantages such technology presents compared to older methods such as exclusively paper charts and related records.

Medical coding skills will likely continue to be in demand in the next decade and beyond due to existing and unforeseen threats to individual and public health, the greater need for healthcare services typical of a population featuring a significant portion that is elderly, and the ongoing impacts of climate change on both health and the infrastructure that provides service delivery.

Medical coding is a growing profession. According to the US Bureau of Labor Statistics, employment within the job series of medical records specialists, to which medical coding jobs belong, is predicted to grow 7 percent from 2021 to 2031. This projection is nearly the same as the average growth rate for all occupations.

Approximately 15,000 openings are projected each year during this time period. Demand will result from job transfers, retirement, and the growing demand for geriatric care as the Baby Boomer generation becomes elderly. Additional less predictable factors such as Covid-19 and other diseases that have not yet emerged could drive demand even higher than currently forecast.

A medical billing and coding job offers additional benefits such as job flexibility. Given the computerized nature of this work, some employees may enjoy working at home part- or full-time so long as they can reliably maintain the security of the information they work with. This flexibility opens this type of work to a larger prospective applicant pool, including working parents, those with mobility restrictions, and individuals with health conditions that necessitate reduced exposure to the general public.

Lisa L Campbell, PhD – DeVry University

Dr. Lisa L. Campbell is a healthcare veteran whose passion is learning, inspiring, and educating others. She began her career as a healthcare professional in 1992 as a certified medical assistant. She is currently CEO of PPR Healthcare Solutions, a full-service company that partners with various organizations to create solutions that increase operational effectiveness, improve clinical documentation, and address compliance-related risks.

Dr. Campbell also has a significant professional background in academic education. She also serves as a professor at DeVry University. She is a subject matter resource in several topics, including clinical documentation improvement, health information management, healthcare management, medical coding, revenue cycle management, and provider and staff training. She previously held a position as adjunct professor at both Davenport University and Colorado Technical University.

She has also shared her expertise as a self-employed professional speaker since the late 1990s. She holds several professional certifications, including RHIA, CDIP, CCS, CCS-P, CPC, COC, CRC and CPMA.

LaTisha Cottingham – Salem State University

LaTisha Cottingham has over 20 years of experience in the healthcare industry. She has six years of teaching experience in medical billing and coding. Currently, she is employed as an HIM analyst for a long-term care establishment based in Tuscaloosa, Alabama. She was a non-credit medical billing and coding instructor for Lawson State Community College for seven years. She currently holds a CPC certification and previously held an RHIT certification.

Her educational background includes a doctorate in theology from Ministry International Institute, a doctor of business administration from Walden University, and a master of business administration from Colorado Technical University.

Karla Pouillon – Everett Community College (EvCC)

Karla Pouillon has been a practicing RN since graduating from the University of Maine, Augusta. She was a float nurse at UWMC for 18 years, a triage nurse on San Juan Island, and a nurse consultant on the Big Island of Hawaii. She currently is the program director for Medical Coding at EvCC.

She has taught in a variety of settings. She previously taught nursing at Renton Technical College, medical assisting at Edmonds Community College, and anatomy and physiology at the University of Hawaii, Hilo. Upon joining Everett Community College, she first taught business technology. She later (1999) started the Health Sciences department before returning to the school’s business division, where she works in healthcare management.
Ms. Pouillon holds a bachelor’s of science degree in biology from Central Washington University and a master’s in education from UW Bothell.

Medical coding and billing professionals can demonstrate their skills through many industry certifications. The American Academy of Professional Coders (AAPC) and the American Health Information Management Association (AHIMA) are the two major organizations that offer medical coding and billing certifications.

Below appears a listing featuring a brief description of some of the most respected and common certifications. This list is not exhaustive. A more thorough description of each certification, eligibility requirements for examination, and other information can be found on the AAPC and AHIMA websites.

CBCS – Certified Billing and Coding Specialist
A certified billing and coding specialist (CBCS) focuses on coding medical procedures, diagnoses, and symptoms into the code necessary to seek insurance reimbursement. This certification requires more than two years of post-high school education, more than two years of work experience, and an examination. The certifying organization for this certification is the National Healthcareer Association. Individuals who hold this certification must renew it every two years.

CPC – Certified Professional Coder
The Certified Professional Coder (CPC) designation is the most recognized certification in the medical coding industry. Those with this credential have demonstrated substantial knowledge in numerous areas, including varied medical services, medical coding guidelines and regulations, medical terminology, and how to navigate the insurance reimbursement process seamlessly.

CPC-A – Certified Professional Coder-Apprentice
The American Academy of Professional Coders (AAPC) offers an apprentice program for those seeking a CPC certification. Those who complete the CPC exam but possess less than two years of professional experience are awarded a CPC-A certification. Individuals with a CPC-A certification can work as certified coders while accruing the additional training necessary to get a CPC certification eventually.

People can fulfill this additional training through either on-the-job experience or completing some continuing education units (CEUs). Precise details on fulfilling one of these two additional training options can be found on the AAPC website.

CCA – Certified Coding Associate
The CCA designation has been a nationally recognized health information management (HIM) certification since 2002. Individuals holding a CCA can demonstrate coding competency in all employment contexts. Those with a CCA stand out from other coding professionals as the AHIMA CCA exam is rigorous.

CCS – Certified Coding Specialist
A CCS demonstrates skill in data quality and accuracy as well as substantial skill in coding. Individuals with this certification have experience coding both inpatient and outpatient records. They also hold the skills to assign numeric codes for diagnoses and procedures listed in patient records, are familiar with ICD-10-CM, ICD-10-PCS, and CPT coding systems, and are proficient in medical terminology, disease processes, and pharmacology concepts.

CCS-P – Certified Coding Specialist – Physician-based
Individuals with this certification work in physician offices, including individual and group practices, multi-specialty clinics, and specialty centers. This certification assesses proficiency in coding beyond a hospital setting.

CCS-Ps are considered experts in health information documentation, data integrity, and quality; hold substantial knowledge of the CPT coding system and the ICD-10-CM and HCPCS Level II coding systems; and may serve as liaisons to insurance companies and public sector entities.

CEHRS – Certified Electronic Health Record Specialist
The CEHRS exam is an industry certification conceived by the National Healthcareer Association. An Electronic Health Record Specialist (EHR) secures a CEHRS to work in a healthcare facility. An EHR ensures patient health information is accurate, organized, and secure. They often work in various settings, including doctors’ offices, private practices, hospitals, and physical therapists.

RHIT – Registered Health Information Technician
The RHIT credential is popular for those seeking advancement to management positions. RHITs often work in hospitals, office-based physician practices, nursing homes, home health agencies, mental health facilities, and public health agencies.

Other settings where those holding an RHIT certification may work include pharmaceutical companies, law firms, and health product vendors. The American Health Information Management Association is the certifying organization for this credential.

CMC – Certified Medical Coder
Medical office professionals with superb coding skills may seek the CMC certification to enhance their professional advancement options. Successful applicants have more than two years of education or training after high school and pass the certification exam. The Practice Management Institute is the certifying organization for this credential.

MCBC – Medical Coder and Biller Certification
An MCBC demonstrates those who hold this certification have several critical skills. These skills include identifying laws, regulations, and guidelines related to medical billing; understanding the medical insurance industry; recognizing many coding systems; accurately completing and sending health insurance reimbursement claims; and preventing of fraud and abuse.

A person possessing an MCBC often holds three jobs: a medical biller, medical billing specialist, and insurance billing specialist. Job duties and salaries vary among these three jobs. A popular training provider for an MCBC is MedCerts. The certifying organization for this credential is the American Medical Certification Association (AMCA).

Those who hold an MCBC may gain additional education and work experience to later successfully enter roles such as medical front office assistant, medical billing specialist, electronic health records and reimbursement specialist, allied healthcare professional, and healthcare administration professional. These five different jobs feature different educational requirements, average salaries, and future advancement prospects.

Just as there are many certifications specific to the medical coding and billing industry, so are a large variety of online medical coding and billing training programs. Several noteworthy programs appear below. This list is by no means exhaustive. Given the consistent need for coders, prospective students will likely find a program within their state of residence. Several of these programs received recent (2022) recognition by Verywell Health for an outstanding aspect of their program.

There is substantial variety in the quality, cost, duration and content of medical coding and billing training programs. Technical schools typically offer training programs of shorter duration at a lower cost.

While such programs can appeal to those who don’t wish to commit to a multi-year education like a four-year degree, it is also generally true that an education featuring a larger investment of time, energy, and money will tend to generate a larger return on investment. It is also important to note that, given the ever-evolving nature of the healthcare system, medical coders should anticipate being expected to be open to continued learning. The medical coding industry will continue to evolve due to changes in available technology, population demographics, and other factors.

The total cost to obtain the requisite education to enter this field can range from $5,000 to $25,000. Tuition pricing typically varies according to factors such as chosen course load, residency status, and past employment history. For example, some programs will offer reduced tuition rates to active-duty military personnel and veterans.

The curriculum a medical billing and coding professional completes typically features content focused on the coding process, common coding languages, medical procedure codes, HIPAA compliance, human anatomy and physiology, and other subjects necessary to create, maintain and securely dispose of medical records and other data used in the course of their work.

Some programs include the following:

Penn Foster

The Penn Foster Medical Billing and Coding Career Diploma Program consists of eleven courses, 40 exams and four submitted projects that ultimately provide approximately 75 continuing education units (CEUs). Students who complete this training may prepare for three certification exams: the CBCS, CPC, and CCA.

Students also benefit from the self-paced quality of this program, an exam preparation study package, a voucher that defrays the cost of taking the CBCS exam, and the ability to start the program whenever they choose.

• Location: Scranton, PA
• Cost: $999 total tuition when paid in full; $1,199 when using a payment plan
• Length: 15 months; fast-track students may complete in as little as 11 months
• Types of courses: Medical office procedures, body systems and medical terminology, electronic medical records, basic medical coding, intermediate medical coding
• Prerequisites: High school diploma or equivalent
• Accreditation: Distance Education Accrediting Commission (DEAC)

DeVry University

DeVry University is a well-known university founded by Dr. Herman DeVry in 1931. Dr. DeVry is the inventor of the first portable motion picture projector. DeVry has a reputation for its commitment to the public good, as evidenced by its collaboration with the Illinois Board of Higher Education, its Advantage Academy, and its involvement in charitable services such as the Boys & Girls Club of America. DeVry seeks to close the workforce opportunity gap through programs designed to help underrepresented student populations.

The DeVry University undergraduate billing and coding certificate program starts every eight weeks and consists of ten courses. Students gain experience with medical billing using a web-based learning platform that simulates a medical record system. Students who wish to study legal and regulatory issues in greater depth can complete three additional courses to specialize in health information coding (HIC).

The DeVry curriculum prepares students to take many certification exams, including the CCA, CCS, and CPC exams.

• Location: Naperville, IL
• Cost: $514 per credit hour; $250 per credit hour for active duty military and spouses; reduced tuition rate available for employees of businesses that participate in DeVry’s business partnership
• Length: 12 months
• Types of courses: Fundamentals of human anatomy and physiology, basic medical terminology, introduction to health services and information systems, health insurance and reimbursement, international classification of diseases
• Prerequisites: High school diploma or equivalent
• Accreditation: Higher Learning Commission (HLC)

Salem State University

Salem State University’s online coding program provides training in various subjects, including the use of the Healthcare Common Procedure Coding System (HCPCS), CPT Category II, and ICD-10 codes. This self-paced, 370-course-hour program can typically be completed in 12 months. Graduates have the knowledge necessary to take the CPC exam successfully. Students may begin this training at any time of the year.

• Location: Salem, MA
• Cost: $2,995; payment plans are available
• Length: 12 months
• Types of courses: Medical terminology, introduction to medical billing and coding, healthcare law, introduction to health insurance terms, pharmacology for coders, medicare, survey of hospital billing
• Prerequisites: High school diploma or equivalent
• Accreditation: New England Commission of Higher Education (NECHE)

Hutchinson Community College

Hutchinson Community College offers a 45-credit certificate program in healthcare coding. This curriculum includes a one-credit health record coding practicum customarily taken in the third and final semester of study. Graduates may take coding positions in various employment settings, including hospitals, clinics, ambulatory surgery centers, and insurance companies.

Courses from this curriculum are available both online and on campus. Many of the credits from this program can also be applied toward the health information technology associate in applied science degree.

• Location: Hutchinson, KS
• Cost: $120 per credit hour for regular in-state students; $151 per credit hour for regular, non-resident students
• Length: Fifteen months (three semesters)
• Types of courses: Pharmacology, human anatomy and physiology, medical terminology, health information processes, CPT coding, reimbursement methodologies
• Prerequisites: High school diploma or equivalent; depending on high school coursework performance, some students may need to take placement tests
• Accreditation: Higher Learning Commission (HLC)

Florida A&M University

Florida A&M University offers a medical coding certificate program. This training provides the skills necessary to become an entry-level coding professional. Graduates of this program are trained to effectively use ICD-10-CM/PCS, CPT, and HCPCS coding programs, interpret guidelines to code accurately, properly interpret documentation for correct code assignment and adhere to AHIMA standards of ethical coding. Successful graduates receive a medical coding certificate and are eligible to sit for the CCA exam.

• Location: Tallahassee, FL
• Cost: Use FAMU net price calculator on the website to calculate the cost
• Length: Consult Admissions for details
• Types of courses: Fundamentals of medical science, pathophysiology, clinical classifications, and terminologies
• Prerequisites: Medical terminology, anatomy & physiology I, anatomy & physiology II
• Accreditation: Southern Association of Colleges and Schools Commission on Colleges (SACSCOC)

University of Cincinnati

The University of Cincinnati offers a 30-credit medical coder certificate program featuring six different start dates throughout the year. Classes are asynchronous, with some designed to be completed in seven weeks and others in fourteen weeks.

Successful graduates have the knowledge base to take the CPC and CCA exams. Students interested in subsequently completing the UC online associate degree program in health information systems can transfer 100 percent of their credits from the medical coder program into this other program.

• Location: Cincinnati, OH
• Cost: Use the school website tuition calculator to estimate the cost
• Length: 12 months
• Types of courses: Medical Terminology for the health professions, foundations of pharmacology, ICD medical coding, health information ethics
• Prerequisites: High school diploma/GED
• Accreditation: Higher Learning Commission (HLC)

Everett Community College (EvCC)

Everett Community College offers a 65-credit certificate in medical coding. Rather than state-regulated tuition, students of this program pay a class fee. This payment structure allows out-of-state students to complete this program at an affordable cost. Upon graduation, students are eligible to take the CCA exam.

EvCC also offers a 35-credit online medical billing specialist program. Students of this program pay tuition. Out-of-state students thus may need to pay an out-of-state tuition rate for this program. Students can complete additional credits to earn an Associate in Technical Arts (ATA) in medical billing and coding.

• Location: Everett, WA
• Cost: Varies according to program, course load, and residency status
• Length: Three to five semesters (1.5 to 2.5 years), depending on the program and pace of study
• Types of courses: Health information & delivery, pathopharmacology, reimbursement & legal compliance, introduction to diagnosis coding, professional practice experience
• Prerequisites: High school diploma or equivalent
• Accreditation: Program accreditation provided by the American Health Information Management Association (AHIMA)

In addition to structured online and in-person programs offered by an accredited institution of higher education and guided by a teacher, students can also pursue their own individualized, self-paced learning using various online resources. Some courses feature a teacher guiding the learning processes, while others do not.

Due to geographic, financial, and mobility considerations, such resources reduce barriers to individuals with limited access to education in their local communities. In addition, as self-taught individuals demonstrate a proactive approach to their own professional development, they may enjoy a larger range of opportunities as an initiative is a quality many employers will find appealing.

The following are some programs that provide more self-directed training:

ed2go

The Florida A&M University Office of Continuing Education offers several online courses for students seeking to advance their education and careers. Subject areas featured on FAMU’s ed2go website include arts and design, business, computer science, health and fitness, and more.

Ed2go offers an online medical coding course in which students familiarize themselves with the CPT manual and ICD-10-CM and how to code the various systems of the human body. This course is good for those interested in taking a first step in exploring a medical coding career.

Coursera

This online educational portal hosts a variety of courses offered by various educational institutions.

Yale University offers a course via Coursera that provides a broad overview of medical software. Course instructors include both Yale professors as well as industry experts. The curriculum includes several subjects: medical device regulatory structures, privacy and cybersecurity regulations, quality management systems and risk management, the medical software life cycle, and business and management issues. This course is suited to third- or fourth-year undergraduate students of computer science, biomedical engineering, and related fields. The course requires approximately 38 hours to complete.

Class Central

Class Central provides users access to an extensive database of some 100,000 courses offered by approximately 1,000 universities, 70 providers, and 600 institutions.

Provider Udemy, via Class Central, offers a coding course entitled Medical Coding: ICD-10-CM Diagnosis Code Training. This course’s objectives include learning the ICD-10-CM medical diagnosis coding series, appropriate code sequencing, coding principles and conventions, and how to identify the proper ICD-10 code for any condition.

Class Central hosts a variety of related courses from numerous providers. Some of these courses include medical terminology, medical technology futures, and medical image analysis.

Bernd Geels

Writer

Bernd Geels is a Berlin, Germany-based freelance writer and artist. He holds an undergraduate degree in atmospheric science and two graduate degrees. He completed his most recent graduate degree in international environmental studies at the Monterey Institute of International Studies in 2011. He is interested in healthcare, climate change, marine conservation, indigenous science, and refugee issues. You can reach him directly at [email protected].