What are Medical Biller and Coders? | Ridley-Lowell Business & Technical Institute

What are Medical Biller and Coders?

By Debbie Brundage LPN, RMA, CPC, AHI

Medical billing and coding workers are the health care professionals in charge of processing patient data such as medical records and related insurance information. Medical insurance billers and coders code a patient's diagnosis, physician visits, office procedures, hospital visits, and hospital procedures along with a request for payments from the patient's insurance company.

What do you need to know to do this?  You must know how to speak medical language and know what the body is made of and how it functions.  These classes are called Anatomy and Physiology and Medical Terminology.  These classes along with learning about insurance and the laws that govern insurance companies are the various components learned in order to work in the various medical billing and coding fields.

In order to bill and code an operative report, you need to be able to read the report (medical terminology) and know what part of the body they are speaking of (anatomy).  Physiology is how your body works and knowing the function of organs will help you understand what procedures were done and to what extent.  An example of all of this would be the sentence:  “I biopsied a lesion of the ileum that measured 4 x 5 mm” which was sent to Pathology.   A biopsy is removal of a piece of representative tissue from the body.   The ileum is a part of the small intestine.  A lesion is a growth.  Pathology is the department in the hospital where they study disease through gross and microscopic examination (seeing with eyes alone and with the microscope). 

You would not be able to read and understand a report without knowing the medical language spoken.  Knowing where organs are would help you understand that the above named “ileum” is part of the small intestine.  The physicians assume you know this.  Medical terminology courses will teach you that a lesion is a growth, pathology is the study of disease and a biopsy is removal of tissue for pathological examination. 

Medical billers and coders can work in physician offices, hospitals, nursing homes, radiology office, laboratories, insurance companies, and ambulance companies to name a few employers.  Understanding the need to pursue the medical portion of being a biller and coder is essential to your studies.  Continuing education is needed in most medical fields and it is true of the Certified Professional Coder, the credentials you receive when you pass your exam through the AAPC. 
Ridley Lowell offers all courses needed to pursue your CPC.

Debbie Brundage has been an Instructor for Ridley-Lowell’s Allied Health programs including medical assisting, medical administration, billing and coding and phlebotomy since 2013.  Her medical career includes working as an LPN/MA at Danbury Hospital. For more information contact info@ridley.edu

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