Program availability
Your Preferences
Update your Zip code, preferred campus, and preferred program
How to Become a Medical Billing and Coding Specialist
Wondering what it takes to become a medical billing and coding specialist? Learn about the day-to-day functions, educational requirements, and skills needed.
Things to know about becoming a billing and coding specialist
Medical coding and billing specialists are the backbone of healthcare operations. Using medical coding and billing processes, they help ensure doctors and hospitals get paid correctly, keep patient records accurate, and help prevent costly errors and fraud.
Because healthcare relies so heavily on digital health records, medical coding and billing specialists are in high demand. If you're detail-oriented, organized, and want to work in healthcare without direct patient care, it's a great career path to consider.
What is a medical billing and coding specialist?
Medical billing and coding specialists bridge the gap between clinical care, insurance reimbursement, and administrative operations. It is a dual role, with two key focuses. Here is a description of both roles broken down into details:
Medical coding: Medical coding helps accurately record and classify the patient’s diagnoses, procedures, and treatments, as well as the medical supplies or equipment provided during care.
Medical coders review patient charts, physician notes, and diagnostic reports. They then translate these services into standardized medical codes, including:
- ICD-10-CM - diagnoses reported in inpatient and outpatient settings
- ICD-10-PCS - procedures performed during inpatient hospital stays
- CPT - physician and outpatient procedures and services
- HCPCS Level II - products, supplies, equipment, medications, and certain services
This allows them to document what was diagnosed and what procedures were performed.
Medical billing: Medical billers take the coded records, generate electronic insurance claims, and submit them to insurance payers (like Medicare, which may cover free or low-cost care) or private insurance companies. They also track unpaid claims, resolve denied claims, and bill patients for the remaining amount. Medical billers help ensure healthcare providers receive accurate and timely reimbursement for the services they deliver.
Why dual expertise matters
Combining both billing and coding skills is a strong advantage in a medical office. The qualifications for one can overlap with the other. For example, when an insurance claim is rejected, a specialist trained in both billing guidelines and coding rules can quickly determine if the issue is a missing modifier (a coding error) or an incorrect subscriber ID (a billing error). Being trained in both billing and coding helps minimize errors, accelerates reimbursement, and keeps the practice's revenue cycle running smoothly.
What are the key responsibilities of a medical billing and coding specialist?
The day-to-day work of a medical billing and coding specialist requires a blend of analytical thinking, technical software literacy, and regulatory knowledge. Typical duties of a medical billing and coding specialist include:
- Insurance verification and authorization: Confirming patient coverage and securing necessary pre-approvals prior to treatment.
- Patient billing support: Addressing inquiries about medical costs, explanations of benefits (EOBs), and statement details.
- Clinical coding: Converting clinical notes and documentation into standard code sets, including CPT, ICD-10, and HCPCS.
- Claim submission: Compiling patient data, medical codes, and insurance details to generate and submit claims.
- Quality control: Auditing claim details for accuracy to reduce processing delays and avoid denials.
- Denials and appeals management: Tracking outstanding claims, correcting rejections, and filing appeals for denied claims.
- Payment processing: Invoicing patients, collecting payments, and arranging payment plans.
- Financial tracking: Overseeing accounts receivable and generating billing performance reports.
- Compliance and record review: Auditing health records for accuracy while maintaining strict adherence to HIPAA, HITECH, CMS, OIG, and federal and state privacy regulations.
Where do medical billing and coding specialists work?
Medical billing and coding specialists often work in hospitals and healthcare clinics; but because the work relies heavily on electronic health records (EHR) and digital communication, they can work in any organization that needs to file, process, or investigate medical insurance claims. This includes:
- Medical and surgical hospitals: Large healthcare environments that handle complex inpatient and outpatient coding workflows.
- Physician offices and private practices: Smaller clinical settings where medical billers and coders may interact closely with office staff.
- Specialized care facilities: Dental offices, radiology facilities, long-term care facilities, home health agencies, and groups that fall outside of traditional hospitals.
- Insurance companies and payer organizations: Here, medical billers and coders work on the insurance side to review, audit, or process incoming claims.
- Billing service agencies: Third-party companies contracted by multiple medical offices to manage their revenue cycles.
- Corporate, legal, and public sector: This typically includes government agencies, law firms, and education institutions
- Remote healthcare organizations: Employers that allow coding, billing, claims review, auditing, or health information work to be completed from home.
What job titles do medical billing and coding specialists have?
Medical billing and coding specialists work across various settings and levels of experience, so they may have a wide range of job titles depending on specialization and responsibility. Some groups and titles include:
Entry-level specialists:
- Medical Coder / Medical Biller
- Medical Billing and Coding Specialist
- Health Information Clerk / Specialist
- Patient Account Representative
- Claims Examiner / Claims Auditor
- Insurance Verification Specialist
- Prior Authorization Specialist
- Revenue Cycle Representative
Inpatient and outpatient specialists:
- Inpatient Coder (focuses on complex ICD-10-CM / PCS hospital admissions)
- Outpatient Coder (focuses on CPT / HCPCS and clinic or emergency visits)
- Professional Services Coder (handles physician billing)
Specialized roles:
- Risk Adjustment Coder
- Clinical Documentation Improvement (CDI) Specialist
- Medical Revenue Cycle Specialist
- Payment Integrity Analyst / Billing Compliance Specialist
- Surgical Coding Specialist
- Denials and Appeals Specialist
- Clinical Data Abstractor
Management and advanced roles:
- Health Information Management (HIM) Supervisor / Director
- Coding Compliance Manager
- Revenue Cycle Manager
- Coding Quality Auditor / Educator
Waived Enrollment Fee
Discover the educational pathway designed to maximize your career potential. Reach for greater heights with Herzing University.
What is the job outlook for medical billing and coding specialists?
The job outlook for medical billing and coding specialists is very strong. According to the U.S. Bureau of Labor Statistics (BLS), employment for medical records and health information specialists is projected to grow 8 percent from 2025 to 2035, much faster than the average for all occupations. This growth is primarily driven by an aging population that requires more routine medical services.
The median annual for medical records specialists (which includes billing and coding specialists) was $51,140 in May 2025. Your salary potential may increase based on certifications, employer, how long you’ve worked, and state in which you work.*
Steps to take to become a medical billing and coding specialist
Most entry-level medical billing and coding specialist positions require either a certificate, a post-high school diploma, or an associate degree from an accredited school. While formal programmatic accreditation is not required, it’s important to select the right medical billing and coding program that aligns with your medical career goals.
- Certificate and diploma programs: Can typically be completed in less than 12 months. Some schools/universities offer fully online programs. Classes typically focus on medical terminology, anatomy, physiology, and basic coding systems, offering students solid fundamental knowledge of billing and coding. Our online diploma in insurance billing and coding specialist can be completed in as few as 10 months.
- Associate degree: An associate degree from an accredited institute in medical billing and coding typically takes less than two years. It combines specialized technical training with general education courses, offering an in-depth understanding of healthcare administration, revenue cycle management, and health information technology. It also helps prepare you for billing and coding certifications from AAPC, AHIMA, and NHA. At Herzing, you can complete our associate's in insurance billing and coding specialist in just 16 months.
Medical billing and coding certifications
While not all medical billing and coding jobs require certification or a state license, passing a certification exam demonstrates your expertise and may increase your earning potential. Depending on the certification, you may need to meet basic educational requirements, complete relevant training, and fulfill organization-specific prerequisites.
Some popular certifications include:
- CPC (Certified Professional Coder): This certification, given by the AAPC (American Academy of Professional Coders), demonstrates recipients’ high competency in outpatient physician-based coding.
- CCA (Certified Coding Associate), CCS (Certified Coding Specialist), and CCS-P (Certified Coding Specialist – Physician-based): These certifications are offered by AHIMA (American Health Information Management Association). Recipients demonstrate mastery-level inpatient and outpatient coding.
- CBCS (Certified Billing & Coding Specialist): Offered by the NHA (National Healthcareer Association), this certification demonstrates combined entry-level certification in billing and coding.
Start your path to a career in medical billing and coding today!
A career in medical billing and coding puts you at the core of patient care and practice operations.
By mastering both roles, you’ll play a strong support role for both patients and physicians – reducing claim errors, speeding up reimbursements, and maintaining a seamless revenue cycle.