Medical Coder Requirements: Education, Job and Certification
This post provides complete information on the requirements you will be expected to meet in the course of building a career as a medical coder.
It discusses the educational, job, and certification requirements you will be expected to meet to become a medical coder and build up your career.
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Medical Coder Requirements for Career Success
If you are interested in a career as a medical coder, here are major requirements you may be expected to fulfill to be successful:
- Medical Coder Educational Requirements
High School diploma or GED equivalency: This program teaches candidates basic knowledge of science and algebra so as to equip students for the main coursework.
This is the first program you need to acquire if you have interest in becoming a medical biller. It takes nine months to a year to complete.
Admission requirements of High School Diploma:
The individual must have completed High School educational program and must have passed the required courses like Chemistry, Mathematics, and Biology.
Associate’s degree: Acquiring an Associate’s degree in Healthcare Administration or Health Information Management is a decisive option for aspiring medical coders.
Employers prefer to hire applicants with Associate degrees on their resume than diploma. Associate’s degree program lasts for two years.
Admission requirements of Associate’s degree:
To enroll in this program, you must have graduated from a High School and have obtained a diploma, excelling in the required courses.
Bachelor’s degree: This is a more advanced degree. For medical coders, it offers a broader and more refined scope in healthcare management.
It impacts knowledge on a wide range of courses, including human resources, health policy, and data analytics, and project management.
Medical coders with Bachelor’s degree are beneficially on top of the hiring list of employers.
Acquiring a Bachelor’s degree prepares you for leadership roles and higher salaries.
It takes up to four years to complete a Bachelor’s degree program in healthcare management.
Admission requirements of Bachelor’s degree:
To enroll for this program, the individual must have acquired an Associate’s degree or High School diploma certificate in the required courses or subjects.
- Medical Coder Job Requirements
Job requirements involve the outline of the required and preferred skills by the employer for the medical coder position.
This may include not limited to education, job experience, certifications, and some technical or soft skills that envision you for a successful hire.
The major job requirements for a medical coder role are:
- High School diploma or GED
- Two or more years work experience as medical coder
- Efficient computer skills
- Excellent communication skills, either written or spoken
- Strong people skills
- Excellent organizational skills
- Ability to keep documents and information confidential.
- Medical Coder Certification Requirements
Employers prefer to hire candidates that have earned certificate qualification from an accredited body.
Earning your medical coding certification gives you an advantage when seeking a job.
Certification guarantees and assures potential employers that you have the right skills and professional qualifications for the job.
The American Academy of Professional Coders (AAPC) offers various types of medical coding certification:
- Certified Professional Coder (CPC): A Certified Professional Coder (CPC) program teaches individuals on the correct application of CPT, HCPCS procedures, codes, and ICD-10-CM diagnosis codes used in medical billing by professional medical service providers and insurance companies.
Requirements: A CPC must have at least two years of coding experience and yearly renewal and CEU requirements.
- Certified Professional Coder – Hospital (CPC – H): A CPC – H examination question entails of the correct application of CPT, ICD-10-CM diagnoses, and procedure codes used by billing facility services and insurance companies.
Requirements: A CPC – H must have a minimum of two years coding experience and yearly renewal and CEU requirements.
- Certified Professional Coder – Payer (CPC – P): The Certified Professional Coder – Payer (CPC – P) credential impact and certifies that the candidate that passed has knowledge and skills to adjudicate provider claims effectively.
The CPC-P certifies the payer coder’s aptitude, efficiency and knowledge within the payer environment.
Requirements: A CPC-P must have a minimum of 2 years of coding work experience, which may include working with CPT, ICD-10-CM, or HCPCS code sets and must maintain the renewal amount of yearly CEUs.
The American Health Information Management Association (AHIMA) offers the following certificates:
- Certified Coding Associate (CCA) : The CCA credential distinguishes certified coders by impacting the knowledge of exhibiting commitment and operating of coding competencies across all settings like hospitals and physician practices.
Requirements: High School diploma or equivalent. 6 months of directly applying coding experience if necessary.
- Certified Coding Specialist (CCS): Certified Coding Specialists are skilled personnel in classifying medical data from patient records in the hospital setting.
These medical coding professionals assign numeral codes for each diagnosis and procedure.
Requirements: To be eligible for this program, you must have completed the following courses: anatomy and physiology, pathophysiology, and reimbursement methodology; pharmacology, medical terminology, and intermediate or advanced ICD diagnostic or procedural and CPT coding.
It also requires minimum of two years of related coding experience directly applying codes.
- Certified Coding Specialist-Physician-based (CCS – P): The CCS – P is a coding practitioner in physician-based settings like physician offices, multi-specialty, group practices, clinics or specialty centers.
This coding practitioner examines patients’ medical records and assigns numeric codes for different diagnosis and procedure.
The Certified Coding Specialist-Physician-based (CCS – P) is for coders who have perfected mastery in medical coding while working in physician offices, clinics or specialty centers.
Requirements: The requirement for this certification is same as for the CCS above.
Medical Coder Responsibilities
A medical coder assigns the correct universally accepted medical alphanumeric code to define the type of service a patient will receive in a healthcare facility.
He/she is a skilled health care coding practitioner responsible for translating medical services such as diagnoses and other medical procedures into codes.
Medical coder offers coding services by taking all documents, notes, and medical transcriptions. The major duties they do are shown below:
- They extract relevant information from patients’ records
- Relating with physicians and other parties to clarify information
- Examine documents, ensuring documents are grammatically correct and free from typographical errors; and sort for missing information if any
- Ascribing of CPT, HCPCS, ICD-10-CM, ASA, APC, and DRG codes
- Ensure all documentation is accurate and precise by conducting audits and coding reviews
- Ensure all codes for services rendered are assigned and sequenced
- Liaising with billing department to ensure all bills are paid in a timely manner
- Contact insurance companies and communicate with them about coding errors and disputes
- They advise and train physicians and staff on medical coding
- They inform supervisor on issues with equipment and computer program
- Ensuring compliance with medical coding policies, ethics, and guidelines.
See detailed medical coder job description here.
If you are interested in starting and building a medical coder career, this post helps you to prepare for the requirements, including educational, job, and certification requirements, you will be expected to meet to be hired and progress in your career.