Certified Coding Specialist Career

The Basics

Various medical specialties play a role in health care. Some medical careers are well known, such as nurses, doctors, and pharmacists. But there are also several medical careers that don’t involve direct patient care including the job of a certified coding specialist.

Certified coding specialists are valuable members of the healthcare team that provide a connection between insurance companies and healthcare providers.

What is a Certified Coding Specialist?

A certified coding specialist is a medical professional who applies alphanumeric or numerical codes to medical services provided to patients. The codes serve a few purposes with one of the most critical being health insurance companies use the codes to reimburse healthcare providers and facilities.

When a medical coder is certified it means he or she has met the minimum requirements to earn a certification in medical coding from a professional organization, such as the American Association of Professional Coders.

Each time a person has a medical encounter, such as a procedure, test or treatment, large amounts of data are recorded in their medical record. The coding system allows the data to be organized and uniform between facilities throughout the United States.

Certified coding specialists assign the codes to medical services from medical record documentation including lab and radiological results along with physician’s transcriptions notes. Having the uniform data system also allows for more efficient research and tracking of health trends.

What Does a Certified Coding Specialist Do?

Certified coding specialists organize and evaluate patient’s medical records to assign a code for billing. The process starts with the coding specialist reviewing a patient’s medical record.

Although it can vary, many patient medical records are electronic, so coders use a computer to analyze charts. Part of the chart review involves determining the patient’s diagnosis and procedures or tests that were performed.

The coder then uses a national classification system and assigns an alphanumeric or numeric code to the procedure or diagnosis. Certified coding specialists use different types of codes. For example, to classify a diagnosis, coders assign an International Classification of Disease (ICD) code, which represents the patient’s condition. The codes assigned determines medical necessity by the insurance provider.

Next, the coding specialist assigns a Current Procedure Terminology or CPT code for surgeries, procedures, and tests the healthcare provider wants to get reimbursed for. CPT codes are a five-character code that may be alphanumeric or numeric. The ICD code along with the CPT code work together to create a picture of why certain procedures, tests, or treatments are needed.

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The specific tools or technology a coder uses to physically assign codes and place them in a patient’s medical record may vary. It’s common for coders to spend a lot of time using a computer. In many cases, specialized medical billing and coding software is used to code. Less common, coders in small practices may still use paper forms to enter codes or a combination of digital and paper files.

Part of the job of a certified coding specialist may also include auditing charts and ensuring codes comply with regulations. Coders also correspond with insurance companies if a claim is denied because of incorrect coding.

Throughout their work, coders may interact with doctors and other healthcare providers to clarify or follow-up on information in the medical record.

Why Do We Need Coding Specialists?

Given the size and scope of the healthcare industry, coding specialists play a crucial role in keeping that industry working as smoothly as possible, particularly in the financial realm. That’s because coding specialists have specialized training that allows them to quickly and efficiently record patient information and procedural information for the purposes of reimbursement.

Since things like insurance and government programs like Medicaid often have a lot of red tape, coding specialists serve the important function of streamlining that process and ensuring that medical professionals are reimbursed for their work in as timely a fashion as possible.

What’s more, given the scope and nature of their duties, these professionals are incredibly important to the financial health of healthcare facilities, from the largest hospitals to the smallest doctor’s offices. For example, if there is an error in a claim, like a missing signature, coding specialists work to rectify the situation and stay in communication with insurance companies or other providers until the situation is resolved.

In that regard, coding specialists also save other healthcare professionals time that can otherwise be spent working with patients and taking on other daily tasks associated with their jobs.

Can a Certified Coding Specialist Work from Home?

A certified coding specialist can work from home. It’s also common for coding specialists to work onsite in medical practices, hospitals, and billing and coding companies.

Some employers of medical practices and coding companies have work-at-home opportunities for coding specialists. Coders who work at home may be employees or independent contractors.

In some cases, companies or medical practices that hire a coder to work at home may supply necessary equipment, such as a computer. In other instances, work at home coders are required to supply their equipment. Typically, companies that offer work at home coding opportunities hire coders that are certified and have at least a few years of experience.

What are the Requirements to Become a Certified Coding Specialist?

Educational Requirements

Coding specialists are not required to have a specific degree or level of education beyond high school. But the professional organizations that offer certification recommend an associate degree in coding. Because coding involves a complex system, formal education is also usually preferred by employers.

Certificate programs in medical coding are offered through technical schools, online colleges, and adult education centers. Admission requirements are usually a high school diploma or completion of a GED.

The goal of certificate programs is to prepare students to work as a coder and to pass the certification exam. Most certificate programs can be completed in six months to a year. Classes in medical terminology, CPT and ICD coding, and medical ethics are included in a certificate program.

Associate degree programs in medical coding are also offered at community colleges and online schools. An associate degree in coding typically takes about two years of full-time study to complete. Although it can vary, 60 credits are usually required to earn the associate degree in medical coding. Admission requirements for an associate degree in coding are usually a high school diploma.

Classes are similar to those offered in a certificate program, but they may be more in-depth. Classes in pharmacology, coding, and medical billing are often included. Some associate degree in coding programs also requires completion of an internship working with a certified coding specialist.

Bachelor’s degree and graduate programs are not available in medical coding specifically. Individuals who want to continue their education and earn a four-year degree in a similar area of study may want to consider a bachelor’s degree in health information.

Certification Requirements

Coders may also choose to become certified. Although certification is not mandatory, many employers prefer to hire someone who has earned a certification. Most companies that hire coders to work at home also require certification.

Two main professional organizations offer certification for coders including the American Health Information Management Association and the American Academy of Professional Coders.

The American Academy of Professional Coders offers several certifications for coders including the ‘Professional Coders Certification’, ‘Outpatient Hospital Certification’, and ‘Certified Inpatient Coder’.

Although an associate degree in medical coding is preferred, it is not required to be eligible to take the certification exam through the American Academy of Professional Coders. But two years of experience working as a medical coder is required to take the certification exam. The exam content may vary depending on which certification is being sought. Most exams involve 150 multiple choice questions. Exam fees may also vary.

Coders can also earn the ‘Certified Coding Associate’ certification from the American Health Information Management Association. A high school diploma is required to take the exam. Although it is not mandatory, it’s recommended applicants have six months of coding experience. The exam consists of 100 multiple choice questions covering coding and billing.

What Do You Learn in a Coding Specialist Program?

The exact curriculum of a coding specialist program may vary. But most programs include similar classes. The classes included in a coding program may also vary by the length of the program. For instance, shorter certificate programs may require fewer classes than an associate degree program. Typically, you learn the following in a coding specialist program:

  • Ethics and Laws in Allied Health: An ethics class examines how laws affect medical billing and coding practices and regulations. Confidentiality of health care information and how medical information is collected is also covered. Certified coding specialists have access to patient’s medical records and need to understand how to ethically perform their job and comply with laws. 
  • Medical Terminology: Medical terminology is often one of the first classes in a coding specialist program. In this class, students become familiar with medical terms related to body systems, medical specialties, and medical conditions. For example, students learn about terms related to specialties, such as pathology, surgery, and oncology.
  • Diagnostic Coding: Diagnostic coding involves applying the ICD coding system to diagnoses. Students learn coding terms, concepts, and procedures.
  • Procedural Coding: Procedural coding classes teach the CPT coding system. Students learn to apply guidelines for classification of procedures. Case examples and practice exercises are often incorporated into procedural coding classes.
  • Coding Compliance: This class examines the reimbursement system for various types of healthcare providers. The class focuses on how coders can ensure they are maintaining compliance with state and federal regulations and laws.
  • Electronic Medical Records: In an electronic medical records class, students are introduced to various EMR software along with confidentiality practices.
  • Medical Billing Procedures: A medical billing class teaches students insurance terms, types of insurance, and how to calculate medical insurance benefits. Information about the reimbursement process, billing cycles and how billing software is used in medical facilities and practices is also taught.
  • Pathophysiology:  In this class, students are introduced to various diseases processes affecting the human body. Students will learn diagnostic procedures related to different medical conditions.
  • Introduction to Pharmacology: The therapeutic use of medicine is studied in an introduction to pharmacology class. Students learn the classification of medications and common terms used.

What are the Advantages of Online Coding Specialist Programs?

Although traditional onsite coding classes are available, online coding programs are also an option. Online certificate and associate degree certified coding specialist programs have the following advantages:

  • Convenience: One of the biggest perks of an online coding specialist program is the convenience. Students can complete school assignments and study at a time that works for them.
  • Flexible Start Time: Traditional onsite coding programs have a set start date. Online programs usually offer a flexible start time, which means, you can begin the program anytime.
  • Cost: Although tuition varies, online coding programs are often cheaper overall than an onsite program. When you consider you won’t have parking and commuting costs, the savings is even greater.
  • Program Length: Many online coding specialist programs can be completed in less than a year, which allows quick entry into the workforce.
  • Class Pace: Online classes in medical coding are usually self-paced. A self-paced class allows you to work at a pace that suits your life. For example, you can complete some classes quickly and take a little longer to finish other classes if life gets busier.
  • Customized Learning Environment: An online coding program may provide a better learning environment than a classroom full of other students or a noisy library. You may be able to concentrate better in an environment you can control.
  • Less Stressful: Commuting and rushing around to try to get to class on time can add to school stress. With an online program, there is no commute or worrying about being late.
  • Promotes Self-Discipline: With an online program, no one is looking over your shoulder to make sure you are in class. Online learning requires self-discipline and motivation, which are helpful skills to develop.

What Does It Take to Become a Certified Coding Specialist?

Several skills and personality traits are needed to succeed as a certified coding specialist including:

  • Understanding of ICD and CPT Codes: Having a thorough understanding of ICD and CPT coding systems is essential. Both coding systems are complex and are central to healthcare providers reimbursement.
  • Efficiency in Microsoft Office Software Including Excel: Coders should be efficient in various types of software, especially Excel. For instance, many medical practices use advanced Excel functions to analyze billing practices, track patients, or compare workflows from previous years.
  • Understanding of Medical Terminology: Coders needs to be knowledgeable of medical terms commonly used to describe conditions, diagnostic tests, and treatments.
  • HCPCS Understanding: The Healthcare Common Procedure Coding System is an important code used by coding specialists. The HCPCS system is used by Medicare and Medicaid along with other services. Certified coding specialists should have a good understanding of the system.
  • Data Management Skills: Certified coding specialists need strong data management skills. Data management skills are needed to gather, validate, and process data efficiently and in compliance with industry standards.
  • Strong Data Entry Skills: Coders spend a large amount of time entering data using software programs. In addition to good tying skills, coders need to have strong spelling, grammar, and reading comprehension skills.
  • Well-Organized: Coding is often fast-paced. There is a vast amount of data to organize. Being organized is essential to deal with quick turnaround times and avoid mistakes.
  • Work Well Independently: Certified coding specialists often have a lot of autonomy. It’s helpful to have the ability to work well with minimum supervision.
  • Analytical Abilities: Having the ability to analyze complex medical information, such as medical diagnoses and treatments, and apply the correct codes is a much-needed skill for coders.
  • Detail Oriented: The medical coding process needs to be accurate. Small mistakes can mean denied claims and cost hospitals and medical practices large amounts of money. Coders need to be detailed oriented.

How Much Does a Certified Coding Specialist Make?

When it comes to medical coding, being a certified coder improves salary. According to the American Academy of Professional Coders (AAPC), the average salary of coders without certification is about $39,900 a year. However, certified coding specialists earn about $52,500 a year according to the AAPC. Salaries tend to be highest in states including California, Alaska, and Washington and lowest in Alabama, Kentucky, and Mississippi.

Having specialized skills also can increase salaries for certified coding specialist. According to PayScale, specializing in auditing, surgical coding, and orthopedics increases salary for coders.

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