11 Skills a Medical Billing and Coding Specialist Should Possess

A medical billing and coding specialist is someone who assigns codes to medical procedures or bills insurance companies for care provided to a patient. Both medical billers and coders need an understanding of medical codes and how to use them to accurately bill insurance companies and to simplify data for analysis by other employees.

Much of the work that medical billing and coding specialists do in our complex healthcare system involves combing through details. In this administrative role, their job is to perform their tasks at a high level and in a way that causes minimal interruption to the care process. This attention to detail is vital, as a mistake can either delay billing, cause a reimbursement claim to be denied or a patient to be erroneously charged for a procedure they did not receive.

If you’re preparing to pursue a medical billing and coding career, it’s important to be aware of the essential skills for the job. These include the technical, or hard skills and workplace, or soft skills that may help you both manage the job well and help you stand out as a strong candidate to employers as you progress along your career path.

But other qualities like a sense of integrity and a consideration for the ethical issues and confidentiality standards that exist in the industry are also important. Medical billing and coding specialists deal with a significant amount of private data, and must comply with industry and governmental regulations such as the Health Insurance Portability and Accountability Act (HIPAA), which protects patient’s medical information.  

Medical billers and coders need to understand the diagnostic and procedural codes that apply to their work, and to the healthcare setting they work in, as they review medical records and build claims for insurance reimbursement. A medical coding professional’s use of ICD-11 and CPT^® codes will vary according to their specific role and whether they work in a hospital, a physician’s office or an insurance company or payer.

Being computer-savvy is essential in any workplace. Because medical billing and coding professionals are immersed in the workflows of the modern health information management field, technical skill in working with specific computer software are particularly essential. Billers and coders need the ability to use workbook and medical billing software, and how to navigate ICD code databases.

It’s particularly important for those working on the medical billing side of things to be familiar with the health insurance industry and how insurance companies examine, process, accept and reject medical claims. Having a working knowledge of how health insurance companies operate helps medical billing and coding specialists communicate with them, and with patients as well.

Medical billing and coding specialists should have the ability to do accounting math. This is necessary when assessing and interpreting financial summaries, determining billing rates and checking for cost discrepancies.

Medical billers and coders often need to work directly with patients as well as with insurance companies. Understanding what it takes to provide excellent customer service can help the entire process flow more smoothly. Medical billing and coding professionals are sometimes called upon to advocate for patients who, due to a costly health event, find themselves in tricky financial situations. Empathy and professionalism are crucial in these situations. When working with insurance companies on behalf of a patient, the same professionalism must be applied to help resolve sometimes complex situations.

Accuracy is crucial in medical billing and coding, as mistakes can result in medical claims being denied, providers losing revenue or patients being billed erroneously. Strong  attention to detail is an ability that can reduce the potential for mistakes and may contribute to more accurate billing and better job performance.

Going hand-in-hand with customer service on our list of soft skills for medical billing and coding, strong communication skills are useful when coders and billers are required to communicate with insurance companies and with other medical or health information professionals. Strong verbal and written communication skills help them collaborate with patients, insurance company representatives and others to resolve issues and expedite the billing and reimbursement process.

An important communication skill, active listening is useful because of the way it demonstrates that you are taking care to understanding and process what others are saying to you. It involves both verbal and non-verbal cues, such as nodding your head, affirmative responses and restating the other person’s statements back to them. Active listening can be particularly helpful in conflict resolution.

When working in this field, knowing how to balance your workload and identify urgent tasks can go a long way toward increasing productivity. This skill enables medical biller and coding specialists to stay focused, manage multiple projects and priorities, and effectively pivot from one project or task to another without losing time.

Staying organized is helpful in any job, but especially so in medical coding and billing. When you have multiple procedures and patients to track, having an exceptional organization system may help you access information quickly, reduce the potential for errors and manage your stress during busy periods. 

When a medical biller needs to work with a patient or insurance company to sort out payment or to dispute an insurance claim denial, strong conflict management skills help medical billers keep these sensitive situations calm and productive. They must be agile, resourceful and well-acquainted with their facility’s policies and procedures for providing assistance, which may involve structuring a payment plan or negotiating a settlement.