How to become a medical biller
Have you considered a career in medical billing? If you’d enjoy working in a healthcare environment but aren’t interested in med school or nursing school, becoming a medical billing specialist may be an ideal career choice. This highly specialized role — while it does require training and certification — does not require a lengthy and expensive college education. It takes only months to become a medical biller, and the flexibility of online training makes it doable for people with busy lives.
What do medical billers do?
Responsible for converting medical codes into billable claims, medical billers are essential to ensuring that physician practices, medical clinics, and hospitals receive all allowable reimbursement for the services they provide. In addition to generating and submitting healthcare claims to insurance companies, medical billers track claims through payer review, post payments, balance accounts, and send invoices to patients when necessary.
Provider organizations depend on accurate and timely claim submissions, which requires knowledgeable medical billers who can navigate the reimbursement system quickly and effectively.
How much do medical billers make?
Because the work of a medical biller is complex and integral to the healthcare revenue cycle, medical billers are valued and well compensated. While pay varies depending on location, employer type, experience, and certifications, the average annual salary for a Certified Professional Biller (CPB)® is $56,652, according to AAPC’s 2023 Medical Coding and Billing Salary Survey.
How do I become a medical biller?
The path from here to a career in health information takes just 7 steps:
Step 1: Determine if medical billing is for you
Step 2: Choose an in-person or online medical billing training program
Step 3: Fulfill CPB essentials & education requirements
Step 4: Study for the CPB exam
Step 5: Take the CPB certification exam
Step 6: Network with your peers
Step 7: Get your first medical billing job
Is medical billing a good career choice for me?
Asking yourself a few questions will help you gauge if medical billing is a good fit, which of course will translate into professional satisfaction and on-the-job contentment. Here are some considerations to get you started:
Can I see myself interacting with patients, office staff, physicians, and payers?
This job will require you to navigate diverse conversations. You’ll need solid communication skills, written and verbal, to feel confident as a medical biller.
Can I remain composed in difficult situations?
Should a patient or insurer take issue with a billing statement or claim, you’ll need to maintain your professionalism. Excellent customer service skills — whether in person, on the phone, or via email — are essential in this role.
How am I with prioritizing tasks?
Medical billing sometimes involves interruptions and multitasking. Will you be able to shift focus, stay organized, and use your time efficiently?
Am I good with secrets?
Confidentiality is the law in this field. You’ll need to respect patient privacy and actively protect patient data.
Do I enjoy a challenge?
Not everything is straightforward in medical billing. How are your problem-solving skills? If you have the creativity to troubleshoot complex issues, you’ll be invaluable to your employer.
Medical billers come in all personality types, from all walks of life. The objective in self-examination is to identify whether you’ll be happy in this line of work.
So medical billing is for you — now what?
As we mentioned earlier, medical billing is highly specialized. There’s a lot to learn — federal regulations, reimbursement methodologies, how health plans differ. But gaining this body of knowledge is what will differentiate you from other medical billers. And the best part is, a reputable medical billing program can teach you the ins and outs of medical billing in 80 hours of coursework and a few 'Essential' classes, all of which take most students about 4 to 8 months to complete, depending on your knowledge and experience in healthcare.
The next step to becoming a medical biller, then, is to think about how you’d like to train and where you’d like to train.
Do you learn best in a physical classroom setting?
Do you need or prefer the flexibility of self-paced studies?
Are you looking for online convenience but want interaction with an instructor and students?
Once you figure out how you learn best, you’re ready to check out various schools and programs.
Do your research before choosing a program. Look for the training features you consider important and, above all, ask about their certification pass rate. How many graduates of their medical billing program successfully attain their CPB credential? You’ll want to choose a program with a high certification pass rate.
Why is certification important?
If you search job listings today, you’ll find many employers equate medical billing certification with medical billing experience. That’s because employers understand how rigorous the certification exam is. Employers look for the AAPC credential because it represents mastery of the skills they rely on. What are some of those skills?
Certification tells employers your skills include the ability to:
Ensure services documented in the patient’s records are coded with correct ICD 10, CPT®, and HCPCS Level II codes
Understand the various types of health insurance carriers, along with their guidelines and reimbursement methodologies
Implement best practices for insurance and patient collections
Prepare, submit, and work a medical claim
Follow up on submitted claims to ensure they’re processed according to contracted rates and benefits
Nothing gives hiring managers more confidence in a medical biller’s proficiency than seeing you’ve passed the national certification exam. Earning your CPB credential endorses your expertise across the medical billing and reimbursement cycle and qualifies you to work in any healthcare setting — health systems, hospitals, physician practices, ambulatory surgery centers, long-term care facilities, rehabilitation centers, dentist’s offices, billing companies, etc.
Essential classes for CPB training
A high school diploma or GED is the only educational requirement you need to enroll in a medical billing program. At AAPC, enrolling in the Certified Professional Biller (CPB)® Certification Course is a simple online transaction.
Because certified medical billing specialists review medical records and medical codes to verify the accuracy of claims, you’ll also need to study anatomy, pathophysiology, and medical terminology. These courses can be taken individually or in a 3-in-1 course, Fundamentals of Medicine. If your education or employment background have provided you with knowledge of medical terminology, anatomy, and pathophysiology, you’re exempt from these medical billing requirements.
Studying for the CPB exam
Passing the CPB exam isn’t easy. You’ll want to be well prepared for test day. Among your time in the books, consider reinforcing your medical billing training with study aids others have found beneficial.
Study tools for CPB exam:
AAPC’s CPB Practice Exams are developed by the same people who created the CPB exam and offer an effective way to prepare you to pass the certification exam. Thousands of students attribute their success to this online resource.
The Official CPB Certification Study Guide reviews each section of the CPB exam and provides practical examples and test taking techniques. Almost 200 exam-quality questions — with answers and rationales — are included in the guide.
Passing the CPB certification exam
Once you complete your CPB training, you’ll want to schedule your certification exam to validate your expertise.
The CPB exam will assess your ability to understand ICD-10-CM, CPT®, and HCPCS Level II code sets, which includes knowledge of medical terminology, as it applies to code sets and reading medical charts. You will also be tested on aspects of the billing cycle, insurance types, compliance with HIPAA, billing and other healthcare regulations, reimbursement methodologies, and collections.
Network at your local chapter
One of the best ways to find a new job is networking. CPB students shouldn’t wait until they’re certified to get involved with their local AAPC chapter.
Local chapters are invaluable for keeping certified billing specialists and medical billing students appraised of what’s happening in their industry. Participation also gives you the opportunity to form relationships with experts, mentors, and peers. The biggest advantage, though, is networking — letting others know when you’re looking for a position and learning about job openings in your area. You’ll find fellow AAPC members eager to support you.
More networking opportunities:
Getting your first medical billing job
Certified professional billers enjoy favorable job prospects. Due to an aging population with greater healthcare needs, employment in healthcare is expected to grow 16% in the next decade, according to the U.S. Department of Labor. The projected 2.6 million new clinical jobs mean more medical billers will be needed to submit, track, and process the rise in medical claims.
But when you’re breaking into any profession, getting your first job can feel intimidating. In addition to tapping into your local chapter, take advantage of the many job-hunting resources available to you as an AAPC member.
Employment tools:
Why train with AAPC?
AAPC is recognized as the preeminent association representing medical coders, billers, auditors, compliance officers, and practice managers. We specialize exclusively in healthcare business education, and our training programs boast pass rates unmatched by any other medical billing and coding school. In addition to leveraging a top-ranked education and the tools you need to grow professionally, you’ll find a 215,000+ network of peers eager to support you throughout the course of your career.
Certified Professional Biller (CPB)®
The CPB credential prepares medical billers with skills to maintain all aspects of the revenue cycle.
Set yourself up for success. Get the pre-requisite training you need.
Medical coding and billing takes time and practice to learn. And getting up to speed on the terminology and knowledge required can be like learning a whole new language.