Insurance Billing and Coding Specialist

If you’re good at details, handling healthcare paperwork could be the perfect field for you.

The healthcare industry literally runs on paperwork – documentation for patient records and payment from the insurance companies. Every time a patient receives a healthcare service, a record is kept of the observations, medical or surgical procedures and treatment outcomes. This record can include the patient’s symptoms and medical history as well as test results, diagnoses and treatment plans.

To get reimbursement from insurance programs or Medicare or Medicaid, medical billing and insurance coders assign a code to each diagnosis and procedure. They use specific software to assign several hundred “diagnosis-related groups” or DRGs to the patient’s bill that explain what procedures were performed and why.

The DRG code is critical to help determine the amount the insurance programs will reimburse the hospital, the doctor and the laboratory. Medical billing and insurance coders must:

• Understand medical terminology
• Enter patient information into computer databases
• Code the proper procedures and diagnoses
• Send the information to the appropriate patients, insurance companies, doctors and medical facilities

A growing field for skilled professionals

Technicians with a strong background in medical coding will be in particularly high demand. Other professionals will be needed to manage the entire process, check for accuracy and secure the information as required by law.

More job openings are expected in doctors’ offices because of increasing demand for detailed records, especially in large group practices. New opportunities will also happen in home healthcare services, outpatient care centers, hospitals and nursing and residential care facilities.