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How to Become a Medical Coder: From Medical Billing and Coding in Schools in Colorado to Certification and Employer Expectations

Colorado billing and coding specialists are hired by a variety of organizations, including medical centers, hospices, and private practices. Their work is vital in ensuring that payers, including governmental organizations like Health First, are charged properly. Sometimes it's vital for medical research as well.

Medical coding specialists assign codes to diagnoses, procedures, and medical supplies. Coding systems vary somewhat by setting. The ICD is used for both procedural and diagnostic coding in many settings. In some settings, though, the CPT is used for procedural coding.

Coding specialists do not need to memorize the tens of thousands of codes in the ICD-10. However, they need to be fluent in their use of the document. They may need to abstract information and request information from medical providers. A coder might, for example, need to contact an assisted living facility to find out symptoms. In short, while a medical doer isn't providing treatment directly, he or she needs some medical knowledge!

Some higher level positions do require academic degrees. Opportunities for advancement include code auditing and revenue cycle analysis. Medical billing and coding trainer is another career advancement option. When there are big changes, as there have been in recent years, there is an increased need for adept trainers.

Certification and education are among the factors that influence salary. The AAPC, an industry-leading certification body, recently conducted a survey of its membership and reported an average salary of $49,978 for those in the Mountain Region.

Select a Colorado Medical Billing and Coding Topic:

Medical Billing and Coding Education in Colorado

Medical billing and coding certificate programs are helpful for those who are starting out.

The American Health Information Management Association (AHIMA) sets minimum educational requirements for newcomers who seek professional-level certification. Candidates who seek the Certified Coding Specialist (CCS) credential or the Certified Coding Specialist Physician-based (CCS-P) credential will need to document having had medical terminology, anatomy and physiology, pathophysiology, pharmacology, reimbursement methodology, and intermediate/ advanced coding using the ICD and the CPT. These courses are not mandatory for candidates who can verify a sufficient level of experience. (Candidates can pursue a lower designation with education at only the high school level, but AHIMA recommends some formal coursework; this does not apply to those who have at least six months of experience.)

The AAPC does not mandate formal post-secondary education for those seeking the Certified Professional Coder (CPC) credential, but does reduce the experience requirement necessary to go from apprentice to full professional status by one year; a qualifying program may be as short as 80 contact hours. The suggested level of post-secondary education is higher – the AAPC recommends having an associate’s degree.

Medical billing has a separate set of requirements. A biller needs to understand the revenue cycle but will not necessarily be expected to have the in-depth coding knowledge that is expected of coding specialists in some settings.

Colorado medical billing and coding programs vary in length and comprehensiveness. Students may select narrowly focused programs – for example, billing only – or may select health information programs that also include coursework in Electronic Medical Records (EMRs). Many programs can be completed in three to six months. Some students will benefit from significantly longer programs. Medical coding may be integrated within an associate program.

Anatomy and physiology and medical terminology may be expected prerequisites or may be incorporated into the program. Programs may be conducted entirely online.

Some students may be eligible for funding. Depending on program and location -- and the student's own employment status/ need for training -- WOIA funds may apply. A number of Colorado programs are WOIA-eligible. Information is available from CO Training Providers (https://www.cotrainingproviders.org).

Employer Expectations

Experience is invaluable. At the early stages, experience may include data entry and computing and typing skills; computer skills may include programs specific to the industry as well as well as the more general office applications. At a later stage, the health facility will likely want to see experience in a similar setting (for example, inpatient) and possibly in a similar medical specialty.

Employer may conduct its own pre-employment assessments. One Colorado employer noted that keyboarding and Microsoft Windows would be among the aptitudes assessed.

Billers and coders also need people skills and general workplace skills. The AHIMA Foundation, cognizant of a school-workplace gap, has put together several ‘Common Employabilty Skills Modules’ (http://www.ahimafoundation.org/education/CommonEmployabilitySkills.aspx). Skills include effective communication, motivating others, and managing conflict, among others.

As for the coding itself -- in some positions, the expectations are very high. One Colorado employer, for example, noted that 97% accuracy would be expected. (A person can enter the field, though, with quite a bit less; it takes experience as well as aptitude to consistently apply the most precise code.)

Medical Billing and Coding Certifications

The most widely recognized and accepted certifications are those granted by the AAPC and AHIMA. Some employers accept others such as the Certified Billing and Coding Specialist (CBCS) granted by the National Healthcareer Association (NHA).

Candidates seeking Certified Coding Specialist certification may download candidate guides from the AHIMA website (http://www.ahima.org/certification). They will need to document education or experience. Experience documented by a letter on letterhead. Once approved, candidates will be granted four-month testing window. Scheduling is through Pearson VUE.

In order to be certified through the AAPC, a person must be a member of the AAPC. It is not necessary to document experience to take the examination – only to remove the apprentice designation. Upcoming examinations are listed on the AAPC website.

In addition to the Certified Professional Coder, the AAPC offers a number of other coding certifications, some of which are applicable only to coders in specialty areas.

Some Colorado employers do like to see specialty certifications such as Certified Interventional Radiology Cardiovascular Coder (CRCC).

Additional Resources

Billers and coders may wish to maintain ties to their own local AAPC chapters. Colorado has ten chapters (https://www.aapc.com/localchapters/).

The Colorado Health Information Management Association is Colorado’s AHIMA chapter (http://www.chima.org). CHIMA is a source of information about initial and continuing education and about practice issues.