What Is a Medical Coder?

medical coder working in a laboratory

Healthcare is an exciting field to work in for many reasons. The entire healthcare field offers tremendous growth and a wide variety of job opportunities. Beyond this, a healthcare career enables people to make positive contributions to their communities. One of the healthcare careers you might consider is medical coding. Medical coders support the efforts of nurses and doctors by keeping health information organized and up to date.

What Medical Coders Do

The healthcare field revolves around information management. Each time a patient is examined, diagnosed and treated, the information in the patient’s file must be translated into alphanumeric codes. These alphanumeric codes are universal in the medical field and are used by hospitals to obtain reimbursement from insurance companies. In short, medical coding professionals are instrumental in keeping hospitals funded and operating, as they enable patients to receive insurance coverage for the care they need.

Specifically, medical coding professionals execute the following tasks:

  • Review patient records, physician notes, laboratory results, radiological results and other medical records
  • Assign diagnostic and procedural codes to each piece of information in these records
  • Develop and submit insurance claims based on the medical codes

It is important to note that medical coders are not the same as medical billers. The former is responsible for submitting claims and often assigning codes. The latter are responsible for coding complex medical claims in the inpatient hospital setting as well as in the provider practice. Medical coders are often found in the role of coding auditor or consultant and aid on claim denials by identifying causes of incorrect coding.

What Medical Codes Are Used

There is more than one set of medical codes. The two most frequently used are the ICD-10 (International Classification of Diseases, 10th Revision) and the CPT (Current Procedural Terminology). Different sets of codes serve different needs in the healthcare world. The ICD-10, for example, assigns a code to every kind of condition, disease, injury, poison and cause of injury. The CPT coding system assigns a five-character code to every kind of medical service that may be provided by a doctor, nurse, therapist or paraprofessional.

Where Medical Coding Professionals Work

Medical coding professionals work in all kinds of healthcare facilities, ranging from large hospitals to small clinics. They also work at surgery centers, nursing homes and specialty treatment clinics, such as dialysis centers. Some medical coders are employed by insurance companies. In this capacity, they work to verify the accuracy of claims submitted by hospital medical coders. Less commonly, medical coders work for law firms. Here, they work on identifying billing fraud. Although many medical coders work on-site, some may work from home as either salaried employees or contract workers.

Some positions for graduates to consider are coding coordinator, medical coding specialist, medical billing specialist, medical records technician, health information specialist and medical records analyst.

Important Skills and Characteristics in Medical Coding

Medical coders can benefit from several skills and characteristics that are transferable across many career paths. They include the following:

  • Clear communication skills
  • Attention to detail
  • Problem-solving abilities
  • Time management
  • Organization
  • Computer literacy

In addition, medical coders must have a thorough knowledge of general medical topics, such as anatomy, medical terminology and medical data classification. They must be familiar with all medical codes used by hospitals to submit claims to insurance companies, including the ICD-10 and CPT coding systems.

How to Become a Medical Coder

Medical coding professionals come from all walks of life. The requirements to enter this profession are generally lower than for other healthcare workers, such as nursing professionals. However, employers do tend to prefer to hire individuals with a relevant degree. You can also earn a medical coding certification, a path that requires attending in-service training. Certification is not required; however, if you prefer to be certified, you can take courses through the Registered Health Information Technicians Organization (RHIT).

Educational Requirements

Medical coders typically attend on of the following:

1) a one-year PCAP (Professional Certificate Approval Program) 

2) a two-year associate degree program in health information management at a community college

3) a four-year bachelor of Science in Health Information management at a university. Graduates of these program often seek related coding certifications. Employers do prefer to hire individuals with a relevant degree and/or certification.

Finding an Internship / How to Gain Experience

Immediately after graduation with a relevant degree, it may be possible to find a position that offers on-the-job training. However, it is common for aspiring medical coders to earn a certificate first from a medical coding program. These programs are offered online or in the classroom and may be completed on a part-time basis. For internship programs, the best way to look is to communicate with your career counselor at school. Career counselors can help you find the most efficient options by providing a list of available programs.

Certificates and Continued Education

After graduating from the certificate program, individuals may opt to enhance their career qualifications further by passing a certification exam. Although this is not mandatory, it does increase one’s competitiveness in the job market. Medical coders can take certification exams administered by the American Health Information Management Association (AHIMA). Some of these programs can take as little as nine months. The training covers analyzing health records and insurance forms, medical billing and engaging with patients.

  • CCA or CCS certification: Certified Coding Associate (CCA®) and Certified Coding Specialist (CCS®) follow a typical path for certified coders:
    • 6 months coding experience directly applying codes
    • Completion of an AHIMA approved coding program (PCAP Program-typically a one-year community college program)
    • Completion of other coding training program to include anatomy and physiology, medical terminology, basic ICD diagnostic/procedural and basic CPT® coding
  • RHIT certification: Registered Health Information Technician (RHIT®): must meet eligibility requirements and pass an exam.
  • RHIA certification: Registered Health Information Administrators (RHIA®) work in various roles within the healthcare industry from entry level analyst to upper level management positions. RHIAs are work as medical coders typically in the acute care hospital setting. RHIAs complete a four-year bachelor of science in Health Information Management program or a master’s degree in health information management at a university.

If you feel that a career in medical coding is a good fit for you, you can get started by earning a preparatory degree at Grand Canyon University. The Bachelor of Science in Health Information Management program is ideally suited to aspiring medical coders, with a curriculum that covers medical terminology, clinical data classification and management, procedural data classification and data governance. Click on Request Info at the top of your screen to explore our dynamic learning community.

The views and opinions expressed in this article are those of the author’s and do not necessarily reflect the official policy or position of Grand Canyon University. Any sources cited were accurate as of the publish date.