# Coder/Biller vs Biller/Coder



## PVAzCPC (Jul 1, 2013)

How does a coder become a biller, as it appears billers are expected to be coders, as well and many more positions are available as such. Coders. per se, do not seem to be much in demand except in in-patient settings


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## Zina (Jul 10, 2013)

The "biller" portion would be knowledge of how to submit claims to the insurance companies, for example, knowing POS and TOS codes, individual insurance company policies, etc. Coders assign CPT and ICD codes to services. 

IMHO


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## la_0922 (Jul 10, 2013)

As a coder and a biller myself, it depends on the employer. If you employ with a single physician or a physician office with 2 providers - you may be required to not only code their visits/hospital/ office procedures, but submit claims, post payments, work on A/R follow up etc. In all honesty in today's economy more and more physician practices are wanting more "bang for their buck" and instead of hiring 2 people, 1 may be enough. 
A well rounded "biller" would also be a coder as well, and vice versa. It would benefit you in the workplace to know both. Specific instances would be working on a claim follow up, if you are not a coder or do not understand coding even at a minimum you are at a handicap, you would need to know correct codes to rebill if necessary, appeal when justified etc. 

In my opinion a biller and coder should be interchangeable -

HTH 
Louise


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## airart (Jul 11, 2013)

*The Career Hats*

I gathered some info from different areas for you.  To save money on employee/positions, many employers do combine positions.  I have seen coders in a biller position and they do the coding part of their job into the E.H.R. and then the biller side of the brain kicks in and they follow through with the electronic claim to the clearing house, or print the claim on paper to be mailed.  

I too have been seeing more and more in-patient setting coders, but they also ask that they have outpatient/ambulatory knowledge too.  I only know of AHIMA who offers the in-patient certification for that.  I was surprised that the CPC-H certification didnâ€™t cover inpatient.  When you look at the demand of healthcare, they donâ€™t seem to be matching.  More often procedures are on out-patient basis or even in the office now.  

I had neck surgery two years ago where they put bolts, a plate, and a cadaver bone in and kicked me out of the hospital a day and a half later in shock.  I was like, â€œHello!!  I just had surgery.â€�    The insurance companies donâ€™t want you in the hospital any longer than absolutely necessary.  Man, my lumbar and cesarean delivery were for five days in-patient, of course those were 5-10 years ago.  Hopefully others will post on this topic too and we can gain some in-sight on these job types.  

Every day I see postings for remote inpatient/outpatient coding.  I miss not being able to work at home.  I am gaining my certs to go back, hopefully eventually I will make it back home.  I would love to be remote again for auditng, billing, claims processing, A/R, appeals/denials, consulting, if anybody knows of any remote positions.  

The Medical Coder 
Medical coders use classification systems to assign codes to various medical procedures and patient diagnoses. The classification system is used for insurance reimbursement purposes. Medical coders enter information that helps determine how much physicians will be reimbursed by a patient's insurance company or other third-party payers such as Medicare or Medicaid. Medical coders are not required to be certified, though many employers pay more for credentialed coding specialists. Certified medical coders earn more on average than coders without certifications. 

Education
Medical coders can obtain a variety of professional certifications. Credentialing authorities such as the Board of Medical Specialty Coding (BMSC) and the Professional Association of Health Care Coding Specialists offer several specialty coding certifications. The average salary of medical coders varies by type of credential and medical specialty. For example, medical coders with the Certified Emergency Department Coder (CEDC) credential earn an average of $50,000 per year, according to the AAPC. The Certified Interventional Radiology Cardiovascular Coder (CIRCC) credential commands an average annual salary of $45,595. Individuals with physician and hospital Certified Professional Coding (CPC) credentials earn between $39,953 and $45,750 per year, according to the AAPC.

The Medical Biller
Medical billers are responsible for collecting, posting and managing medical account payments for medical billing services, large doctors' offices, hospitals or health facilities. A biller submits billing claims to health insurance companies and does all the follow up including phone calls to the insurance companies and to the patients. If there are any complaints from patients they handle those as well. They may often set up payment plans to help patients pay their bills on the remaining amount owed after health insurance claims are paid. These are some of the basic duties; they are also known to help the front office checking in/out patients as well, answering phones, etc. Special billing software is used.  A high school diploma or GED is usually required by most companies with available jobs.

The Medical Billing Specialist
What is a Medical Billing Specialist? Is that the same as a Medical Biller? The answer is No. The difference between a Medical Biller and a Medical Billing Specialist is this: Medical Billers do not necessarily have the certification credentials that a Medical Billing Specialist has. To become a Certified Medical Billing Specialist (CMBS), you need to a take a certification exam administered by the Medical Association of Billers (MAB). AAPC has a new one that started April 2013, Certified Professional Biller (CPB.)  While the certification specialist designation is not required to get a job as a medical biller, it is certainly recommended.  Becoming certified will better your chances for getting the position.
I have seen most often the biller handles all the initial submissions to the carriers and the Medical Billing Specialist will handle the denials/appeals to carriers.  They work together to handle backlog of either.  Most often, there is only one position to do all.

The Medical Payment Poster/Processing Specialist
As Payment Processing Specialist, you will have responsibility of ensuring all medical payments received by mail, electronic downloads or telephone are applied to patient accounts in a timely and accurate manner. You will also be maintaining daily balancing (credits/debits) reports and submit reports to others in the office or office manager/supervisor. 
Education: High School Diploma and a minimum of three year of work experience in billing, accounting/bookkeeping and collections in the health care industry.  
Experience and Qualifications: 
â€¢ A minimum of 3-5 years of previous billing, accounting/bookkeeping and collection experience required. 
â€¢ Previous experience with CPT, ICD9 coding, and working with third party administration preferred. 
â€¢ Knowledge of non-contracted; HMO, PPO, EPO, POS, Workers Com., and third party reimbursement issues. 
â€¢ Excellent organizational, interpersonal, telephone, documentation, and communication skills. 
â€¢ Must demonstrate a strong attention to detail, someone who is courteous, professional and who can adept to handling multiple tasks and consistently meeting deadlines. 
Licenses/Certificates: None Required 


The Medical Collector
The Collector will be responsible for thorough and timely patient account follow up to ensure accurate accounts receivable reporting; to ensure payment by primary and secondary payers and/or self-pay patients are accurate. The Collector will be responsible for daily generation of patient statements. The Collector will be responsible for answering patient calls and correspondence while providing timely, accurate, professional responses and resolution.
Education: High School Diploma and a minimum of three year of work experience in billing and collections in the health care industry.
Experience and Qualifications: 
â€¢ A minimum of 3-5 years of previous billing and collection experience required. 
â€¢ Previous experience with CPT, ICD9 coding, and working with third party administration preferred. 
â€¢ Knowledge of non-contracted; HMO, PPO, EPO, POS, Workers Com., and third party reimbursement issues. 
â€¢ Excellent organizational, interpersonal, telephone, documentation, and communication skills. 
â€¢ Must demonstrate a strong attention to detail, someone who is courteous, professional and who can adept to handling multiple tasks and consistently meeting deadlines. 
Licenses/Certificates: None Required 
Practices tend to group positions as one with AR Posters/Collectors.

The Jack of all Trades 
This is the miracle worker of any small practice that tries to do all of the above positions by themselves.  I am sure they are not receiving all three of their salaries they should be entitled too.  If that was true, I would definitely change over.  So sad, every time I come across one I just want to jump over the ledge and give them a hand.  Even sadder when I see the doctor I am there to see and give them a piece of my mind.  Time management is a big key to their achievements.  Most of the ones I come across are luckily single practice doctors who are not trying to tip the scales and squeeze in more patients.


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