Medical Coding Specialist: Job Description and Requirements

Medical coding specialists are responsible for correctly coding healthcare claims in order to obtain reimbursement from insurance companies and government healthcare programs, such as Medicare. Qualified medical coders can earn the Certified Professional Coder (CPC) credential through the American Academy of Professional Coders (AAPC).

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Medical Coding Specialist Job Description

Medical coding specialists work in hospitals, clinics and physicians' offices to obtain accurate reimbursement for healthcare claims. They utilize specialized medical classification software to assign procedure and diagnosis codes for insurance billing. Coders also review claims data to ensure that assigned codes meet required legal and insurance rules and that required signatures and authorizations are in place prior to submission. If a claim is denied due to incorrect coding, the coding specialist conducts medical records research and corresponds with insurance companies and healthcare professionals to resolve the issue.

Recommended Education for Medical Coding Specialists

Medical coding specialists generally complete a 2-year program leading to an associate's degree in medical coding, health information technology or another closely related field. Typical coursework includes classes in medical terminology, basic and advanced ICD-9-CM coding, anatomy and physiology, computer data entry, and medical law, privacy and ethics. CPC candidates might benefit from advanced courses in Healthcare Common Procedure Coding Systems (HCPCS), Current Procedural Terminology (CPT) coding and healthcare reimbursement methods.

Certification Requirements for Medical Coding Specialists

Medical coding specialists can advance their career opportunities by obtaining certification through the AAPC. Requirements for the CPC credential include current AAPC membership, two years of experience as a medical coder and successful passage of an exam. An associate's degree in medical coding or a related field is recommended but is not required for certification. CPCs must maintain annual membership in the AAPC and submit 36 continuing education units every two years for recertification.

In addition to the CPC designation, which is intended for medical coders who work in physicians' offices, the AAPC offers certification in CPC-Hospital, CPC-Payer, Certified Interventional Radiology Cardiovascular Coder (CIRCC) and Certified Professional Medical Auditor (CPMA). The association also offers 19 stand-alone credentials in areas such as anesthesia and pain management, dermatology and urology.

Medical Coding Career Outlook

Medical records and health information technicians were predicted to see 22% job growth from 2012-2022, according to the U.S. Bureau of Labor Statistics (BLS). This was an above-average increase due in part to an increased aging population and the computerization of medical records. Medical records and health information technicians earned an average salary of $37,710 in May 2013.

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Source: Bureau of Labor Statistics