How to become A Medical Coder

Medical Coders act as a linguistic bridge between the patient and insurance companies, government agencies and law firms worldwide. They review and translate medical files into universal alphanumeric codes so insurance claims are rightfully reimbursed.

• Clinical Coder
• Clinical Coding Officer
• Diagnostic Coder

What do Medical Coders do?

A Medical Coder would typically need to:

• Decipher laboratory results, procedures and diagnoses; assign appropriate universal medical codes to them for data management and billing purposes
• Ensure that codes are assigned error-free and follow the specific guidelines of the relevant hospital, insurance company or governmental agency 
• Comply with the confidentiality policies 
• Talk to physicians, nurses and other healthcare providers for clarification and additional information
• Follow up with healthcare practitioners or insurance companies regarding insufficient documentation
• Advocate on behalf of patients; evaluate and resubmit unsuccessful patient claims 
• Check patients’ history and records if needed 
• Review new patients’ documents and charts for correct and sufficient information; review previous days patient charts for coding 
• Stay updated with new codes and changes made in the coding system; ensure all assigned codes are accurate 
• Train other healthcare practitioners on the medical coding system, if required 
• Inform superiors or the appropriate authorities if there are any issues with the coding or medical software
• Develop good relations with healthcare practitioners, clients and insurance companies that they interact with
• Be prepared to answer queries regarding coding or regarding cases handled

Medical Coders can work remote or freelance in many instances since they have minimal contact with patients and need a computer to communicate with other healthcare professionals for accurate information. On-site work in healthcare settings is also possible.

Whether they choose full-time or part-time work, Medical Coders might have to work in shifts or overnight at 24-hour facilities. Your employer may allow you to set your work schedule as long as it matches their needs. 

Finding a new job might seem challenging. Medical Coders can boost their job search by asking their network for referrals, contacting employers directly, using job search platforms, going to job fairs, leveraging social media and inquiring at staffing agencies. Self-employment is a viable option.

Medical Coders are generally employed by:

• Hospitals
• Doctor’s Offices
• Healthcare Consulting Agencies
• Nursing Homes
• Surgery Centres
• Home Healthcare Agencies
• Mental Health Facilities 
• Dental Offices 
• Long-term Care Facilities
• Law Firms
• Insurance Agencies
• Education Institutions

Healthcare associations and professional organisations, such as the American Academy of Professional Coders (AAPC), The Association of Registered Healthcare Professionals (ARHCP), and the Institute of Health Records & Information Management (IHRIM), provide unparalleled networking and educational opportunities. They offer all the certification courses members will need throughout their professional careers.

Affiliated Medical Coders may attend conventions, seminars, and dinners frequented by peers, mentors, and other industry leaders. The events help them keep up with the newest breakthroughs and latest developments in the field, including plum jobs.

• Learning and accurately applying the medical codes; ensuring that the codes are error-free 
• Following the HIPAA (Health Insurance Portability and Accountability Act) and HITECH Act (Health Information Technology for Economic and Clinical Health Act) confidentiality rules when applying codes and discussing patients’ cases 
• Staying updated with new codes and changes in coding systems and software 
• Communicating regularly with third parties like insurance companies and government agencies

The demand for Medical Coders is increasing rapidly, leading to competitiveness in the field. Candidates with experience in clinical program management and health record management, in addition to medical coding guidelines and procedures, will have the edge over their peers.

Related work experience gained through employment, voluntary positions or internships can be beneficial when applying for jobs since it sets you apart and prepares you for working in a medical setting. Some education providers mandate a clinical coding apprenticeship with an emphasis on clinical coding standards.

Any experience in keeping medical records or working in the front office of a healthcare facility would facilitate entry into the world of medical coding.

It would be best to apply for work experience positions while you complete your studies. This way, as soon as you have your diploma and certification, you can apply for relevant jobs.

Shadowing an experienced Medical Coder and reading about medical coding are also relevant activities that can help you familiarise yourself with the demands of the job. Furthermore, it is good preparation for interviews with potential employers. 

While some employers may accept a Medical Coder with a high school diploma, most medical facilities would favour applicants with a master’s or bachelor’s or at least an associate degree.

Relevant programs include medical coding and billing, health information technology, healthcare administration or a related field of study. Ideally, students will learn about anatomy, physiology, medical procedures and specific insurance rules and policies. Knowledge of health data standards, classifications and coding systems is vital, as are computer classes to enhance your data and record-keeping skills.

Of vital essence is comprehensive knowledge of multiple sets of medical codes that include classifications of diseases and surgical procedures besides listing all physician services.

Employers prefer applicants who have already been certified or are willing to acquire certification soon after recruitment.

To enter the job market, you should attain a general or standardised certificate from a reputable organisation. As a certified Medical Coder, you will stand out to employers in the job market and have the mobility to apply at more establishments.  It will also increase your sense of self-confidence.

Some locations mandate a nationally-recognised clinical coding qualification. You can also obtain more specialised certification that prepares you to work in a hospital setting or doctor’s office. Additional certifications in specific concentrations such as cardiology, dermatology and gynaecology will facilitate career progression.

Alongside certification for medical coding, you can also enrol in courses that aim to improve your organisation skills, computer literacy, record-keeping skills and communication skills to serve as a more accomplished Medical Coder. 

With experience and further knowledge, there are some opportunities for career progression within medical coding. 

After some years, provided the opportunity exists at your workplace, you can be promoted to Coding Manager or Specialty Coder, which are considered second-step careers. As a Coding Manager, you would be in charge of implementing new policies and hiring and training new employees. A Specialty Coder specialises in a particular concentration of illnesses and has expert billing, treatment, and coding systems knowledge.

Upon developing needful management skills and experience, you can be promoted to Director of Medical Coding or Director of Compliance, which are considered third-step careers. As Director of Medical Coding, you would oversee audits and policy implementation, while the Director of Compliance supervises training sessions and continuing education and meets with team members to discuss issues.

Candidates with certification, experience, subject matter expertise and an excellent work record have the best job prospects. 

Continuing professional development (CPD) is essential in the healthcare sector for public wellbeing and career progression. It embraces new learning objectives, methodologies, and novel technological developments, especially in education, management, and IT.

Reflective learning, interaction with peer groups, comprehensive inclusion, workshops, certification courses, and professional publications educate, influence, support, and foster lifelong enlightenment in all career-grade Medical Coders. 

The easiest way for a Medical Coder to continue professional development is via certification. Apart from the general introductory course that most Medical Coders take, you can obtain many additional certificates to highlight your competency and versatility. 

Some certification options include the following: Certified Outpatient Coder (COC), Certified Coding Specialist (CCS), Certified Professional Biller (CPB), Certified Inpatient Coder (CIC) and Certified Risk Adjustment Coder (CRC). Certification usually leads to advanced roles with more responsibility and payment.

You can also acquire certifications that prove your proficiency in a particular area. Options include getting a certification in coding for cardiology, family practice, paediatrics, oncology or dentistry.

Codes You Will Learn

As a Medical Coder, you need to be familiar with thousands of codes to work effectively. Among them are the International Classification of Diseases, 10th Editions (ICD-10-CM), which has 69,000 codes for all kinds of diseases and Current Procedure Terminology (CPT), which has 8,000 codes representing physician services.

Also included are the Health Care Procedural Coding System, Level III (HCPCS Level III), which has approximately 7,000 codes that help with medical billing for insurance companies and the International Classification of Diseases, 10th Edition, Procedural Coding System (ICD-10-PCS), which has 130,000 codes relating to different surgical procedures. You also need to know Diagnosis-related group (DRG) codes and Ambulatory Payment Classifications (APC) codes.

In addition, you will learn the codes for specialised fields such as dentistry or oncology if your interest lies in that direction.

Courses You Will Undertake

In principle, your academic program should teach you about diagnostic coding, billing and coding application, procedural coding, medical terminology, introduction to computers, and healthcare communication.

Besides, you will learn about medical law and ethics, anatomy, physiology and pathophysiology, records management, healthcare settings, claim cycles and claims processing.

Size Matters

Medical Coders working for a relatively minor health facility will likely be in charge of all medical coding tasks or have more responsibility. On the other hand, in a larger facility, you will probably work in a large team and be responsible for a specialised aspect such as outpatient or inpatient surgeries.

The Current Scenario

An ageing global population requires more medical services. Consequently, there is an increased demand for Medical Coders and other health information workers and healthcare professionals. As a Medical Coder, you are in demand because more claims need to be sent and filled out for reimbursement from insurance companies.

Medical coders take the help of sophisticated software to track and assign the thousands of codes required by medical claims.

Medical Coders work behind the scenes to ensure that healthcare facilities continue to fulfil their promise to provide the best services to their patients. Because of Medical Coders, patients and hospitals are reimbursed accurately by insurance companies. 

When hired, have a look through previous superbills and claims forms to get an idea of the flow of your new workplace. Learn from your mini-audit and see what you should do differently to be better at your job.