What is a medical biller?

A medical biller ensures claims are processed in a timely and accurate manner, supporting strong cash flow and revenue for healthcare organizations. Common duties of a medical biller include:

• Completing claims forms and billing insurance companies on paper and electronically

• Resolving denied claims by resubmitting them with corrected data or sending appeals paperwork

• Communicating with patients about outstanding balances

Depending on the organization’s size and structure, medical billers might specialize in insurance companies or procedures, handling only claims that match their workflow.

What is a medical coder?

A medical coder assigns diagnosis and procedure codes to medical records and claims. Accurate medical coding is critical to ensuring appropriate patient care and timely payment of claims. Potential duties of a medical coder include:

• Reviewing health records and forms to assign codes following insurance requirements and manuals, such as the International Classification of Diseases (ICD)

• Communicating with clinical and administrative staff members about codes to ensure accuracy

• Determining the best diagnosis or procedure code based on the documentation provided

Similarities between medical billers and medical coders

When comparing medical billing vs. medical coding, you may find similarities. Both healthcare administrative positions are critical to revenue generation and back-office workflows. The roles require attention to detail, effective communication skills and an understanding of revenue cycle management.

In some cases, particularly in smaller healthcare offices, these positions might overlap or be combined. However, in larger healthcare organizations, they’re typically separate, and medical coders tend to be more connected to clinical processes than billers.

Differences between a medical biller and a medical coder

When choosing whether to hire a medical biller or a medical coder, it can be helpful to understand the differences.

Education or certification requirements

You may want to hire medical coders with certifications such as the Certified Coding Associate (CCA) from the American Health Information Management Association (AHIMA) or the Certified Professional Coder (CPC) certification from the American Academy of Professional Coders (AAPC).

Depending on your new hire’s autonomy with their duties, you might also want someone with an associate’s or bachelor’s degree in medical records, healthcare administration, medical coding or another relevant degree.

In contrast, many employers hire medical billers without certificates or degrees and opt for skills-based hiring. For example, candidates with Certified Professional Biller credentials from AAPC or other certifications may be preferred but not required.

Necessary skills and knowledge

While the skills required for these jobs often overlap, medical coders typically need a strong understanding of medical terms, anatomy and physiology. They must also read and interpret medical record narratives and data to apply the correct codes.

Medical billers tend to need more knowledge of insurance claims and reimbursement processes than coders do.

Patient interaction

Medical coders and billers are back-office healthcare admin positions, resulting in limited interaction with patients. Medical coders rarely speak with patients.

Depending on how the revenue departments are organized, a medical biller might work with patients to collect payments or update insurance information to support claims processes.

Pay

According to Indeed salary data, medical coders in the United States make an average of $26.30 per hour, while the average pay for medical billers is $20.37 per hour. Coders likely make more on average due to the higher knowledge requirements for those positions.

How much you pay medical billers or coders depends on your location, what local competitors are paying, the level of work and decision-making required for these positions and the type of facility.

Medical biller vs. medical coder: Which one to hire

Hiring in the healthcare industry can be a complex endeavor, and it’s important to start with an understanding of what your organization needs. When choosing medical billing or coding professionals, consider the benefits each might bring to your business.

Benefits of hiring a medical biller

Medical billers can help:

• Improve cash flow through timely billing

• Reduce insurance denials with accurate billing

• Help recover old accounts receivable through insurance appeals

Benefits of hiring a medical coder

Medical coders can help:

• Support safe patient care with accurate records

• Enhance the accuracy of claims billing with coding

• Act as a knowledgeable communication bridge between clinical documentation and back-end administrative processes

How to choose between a medical biller and a medical coder

To determine whether to hire a medical biller or a medical coder, consider the following questions:

• Do you want a streamlined claim workflow? A medical biller can help secure your profits with timely filing. They can also assist with backlogged denials.

• Could coding accuracy be improved? If records and claims audits have a high rate of inaccurate diagnoses or procedure codes, you may need a medical coder.

• Can you cross-train a new hire? Smaller healthcare offices might want to hire someone who can handle coding and billing tasks. In this case, consider hiring someone with medical coding knowledge, as it may be easier to train someone on billing than coding.

Frequently asked questions about medical biller vs. medical coder roles

Are there alternatives to hiring full-time medical billers and coders?

Anytime you’re considering hiring healthcare professionals, including medical billers and coders, you may want to first assess alternative options such as temporary staffing or outsourcing.

You might utilize medical billing and coding service companies to help meet your needs without hiring a full-time biller or coder. Employers that only need help clearing temporary backlogs or reducing labor costs might outsource medical billing or coding tasks.

Do you need medical billers and coders?

Whether you need a medical biller and a coder depends on the size of your facility, the nature of your healthcare service and the structure of your back-end healthcare office.

Some small specialty offices, such as durable medical equipment providers and PT clinics, only have medical billers. In these cases, the diagnosis and procedure codes are streamlined, and clinicians can easily choose from the drop-down menus on electronic medical records. However, in larger organizations, coders may be required to ensure accuracy.

Can you train medical billers in-house?

Yes, you can train medical billers in-house if you hire someone without previous knowledge or a medical billing certification. Consider looking for job applicants with strong attention to detail, good communication skills, computer knowledge and a desire to learn medical billing.