We all know the headache of trying to make sense of medical bills. But if you're a certified professional coder, all that complexity represents a fine career opportunity, with salaries and job growth looking robust.
What do certified professional coders do on the job? They translate physician notes, laboratory and radiology results into medical code so those services can be billed or reimbursed properly and in full. They must do so in a way that ensures compliance with laws and regulations, and protects the privacy of patients' health information.
A typical day for a certified professional coder
First, you'll probably head to work at a physician's office, group practice, hospital or other health facility. That said, some coding and/or billing firms offer flexible, home-based opportunities as well.
Once at work, you'll gather patient notes and exam results from the previous day and begin translating them into medical code.
While most cases are straightforward, some are likely to fall into gray areas that require more research. That may include consulting professional documentation, seeking guidance from fellow medical coders, and/or sending queries to the physician, nurse and other health provider who created the original document.
Once you have finished creating coded notes, you'll need to check your work and then turn it over to the billing team. In some facilities, especially smaller offices, the certified professional coder may also handle billing, though that is considered a separate professional function.
Demand, salaries for the year ahead
According to the 2019 OfficeTeam Salary Guide, the midpoint salary for a certified professional coder in the United States is $53,000.
Medical coding managers — those responsible for the work of certified professional coders — can expect to earn significantly more. The midpoint salary for this role in the United States is $66,250.
Demand for medical coding professionals is heating up. According to the U.S. Bureau of Labor Statistics, the number of jobs in medical records and health information fields will grow by more than 15 percent in the decade leading up to 2024.
Reasons for such rapid growth include:
- An aging population requiring more medical care.
- Constantly changing rules and regulations.
- A growing number of new medical treatments and procedures.
What are the required hard skills?
Certified professional coders must demonstrate a strong understanding of human anatomy and medical procedures — and the rules and regulations that define how to code them in health records and insurance claims. Specifically, they must demonstrate the following:
- A solid understanding of anatomy, physiology and medical terminology — including evaluation and management, surgery, anesthesia, radiology and pathology.
- Extensive knowledge of CPT®, HCPCS Level II, and ICD-9-CM Volume 1-2 medical code for diagnoses and procedures.
- The ability to translate provider notes into accurate code.
- The ability to quickly identify problems and query providers to ensure proper coding.
- Knowledge of medical coding guidelines and regulations governing reimbursement and compliance.
- Ability to keep current with medical coding and payment policy changes, and to ensure they are integrated into reimbursement processes.
What about interpersonal skills?
While most medical coders perform their work independently, good soft skills are a definite plus. You may have to interact regularly with nurses, doctors and other office administrators. In some cases, certified professional coders must also engage in the difficult task of explaining to patients why a specific claim is rejected.
Of course, such skills are also important if you want to expand into other areas of medical coding and billing, or to advance to a managerial position.
Education and training
While not required, an associate's degree is generally expected, and a bachelor's degree can make you even more attractive to employers. Any classes that focus on anatomy, physiology, disease processes and medical procedures can provide a good foundation. Some colleges and universities provide training specific to the profession.
There are also both in-class and online private courses that focus specifically on medical coding, though be sure to research a program's quality and reputation before investing time and money.
Earning CPC certification
While coursework and years of industry experience can be enough for a successful career in medical coding, the Certified Professional Coder (CPC) certification from the AAPC — formerly known as the American Academy of Professional Coders — provides a big leg up. To earn this certification, you must:
- Pass an exam — You must take an exam covering 24 different areas, including medical terminology, diagnostic codes, coding guidelines and specific coding for more than a dozen specific fields.
- Demonstrate on-the-job experience — Show that you have spent two years working with CPT, ICD and HCPCS codes — or that you have had 80 hours of coding education.
- Engage in ongoing education — Complete 36 hours of continuing education every two years to keep up with new medical treatments and changing coding regulations.
The CPC exam is a five-hour-and-40-minute marathon involving vast amounts of technical information. The AAPC estimates that nearly half of all exam takers fail the test the first time, so extensive preparation is must. The AAPC can recommend specific course work and literature to help you get up to speed.
Career paths for successful CPCs
Since jobs are plentiful, and the average certified professional coder salary is rising, this is a great time to enter the job market for this role. For those who want to move into management or other higher-paid positions in the medical coding field, there are plenty of options, including:
- Advanced certification — The AACP offers advanced certification in 22 specialty fields, from ambulatory surgery to urology. Such certification increases job prospects and tends to command a higher salary.
- Medical coding auditing or management — These positions require more expertise and experience but will yield significantly higher salaries.
Download the OfficeTeam Salary Guide for the most accurate starting salary information, hiring insights and more for the administrative field.