Medical coders play a vital role in bridging the gap between healthcare providers and insurance companies, regardless of whether they work in a hospital, physician's office, or skilled nursing facility. The primary responsibility of medical coders is to communicate patient diagnoses and treatments to insurers in a manner that enables them to determine the appropriate reimbursement for medical services provided by physicians under the patient's policy.

The role of medical coders is crucial in the healthcare system as they are responsible for converting physician reports into appropriate medical codes. These codes serve multiple purposes, ranging from being utilized by insurance companies to research organizations. Medical coders regularly communicate with various professionals, including physicians, insurers, and patients, to keep them updated on the status of medical bills.

Hiring a medical coder can result in a more efficient process and a consistent payment schedule, ultimately reducing the stress associated with submitting and collecting payments from insurance companies. These specialists are not intimidated by the complexities of medical billing law, from identifying the appropriate codes to submitting them to the insurance company and subsequently waiting for payment or denial before initiating the process anew. The purpose of this article is to provide valuable insights and expert guidance that can aid you in effectively managing the hiring process for medical coders.

The Vital Role of Medical Coders: Understanding Their Duties and Responsibilities

Medical coders typically spend their workday converting the information given by healthcare providers into medical codes. These codes are then transmitted to medical billers, facilitating the process of medical coverage. Medical coders are in relatively high demand. The BLS also predicts an additional 12,300 jobs will be added between 2021 to 2031. Source

Below is an elaborate list of the tasks performed by medical coders daily.

Examine patient data

Medical coders analyze medical charts and convert the healthcare services rendered to patients into the appropriate medical code, which may vary depending on the healthcare insurance provider

Revise medical records

It is crucial to maintain current medical data, and medical coders are responsible for updating and inputting data into patient records and accounting systems. This practice helps to simplify the insurance claim process and minimize errors in the medical billing process.

Collaborate with stakeholders

Medical coders collaborate with various stakeholders, including healthcare providers, insurance companies, and other entities involved in the process to ensure accurate and legitimate medical insurance claims.

Enter medical codes

Medical coders employ medical codes, including universal code classifications like the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10 CM), and Current Procedural Terminology (CPT), to generate medical claims for the medical billers.

Research medical records for medical coding accuracy

On occasion, medical coders may identify discrepancies or mistakes in the information provided by healthcare providers. As a result, they may need to research to ensure that the medical claim is processed accurately, using the appropriate medical code.

Decoding the Medical Lingo: Essential Skills for Medical Coders

Detail-Oriented

To be a competent medical billing specialist, it is essential to possess the skill of paying close attention to every aspect of the information recording process. This involves asking pertinent questions and collecting all the necessary data to effectively manage claims.

Moreover, they need to ensure that no field is left incomplete when submitting the claim to an insurance agency.

Effective Communicator

There is a widespread belief that medical coders work in isolation without interacting with others, but this is not true. Competent medical coders must have strong interpersonal skills to communicate effectively with important individuals. Moreover, they often need to confront difficult situations to overcome collection challenges. During these situations, skilled professionals use clear communication to express their concerns and collaborate with individuals to expedite payment collection.

Technical Skills

Although they do not require advanced technical skills, medical coders must possess a fundamental knowledge of coding software to perform their tasks accurately. Electronic Health Records (EHRs) are frequently used for different billing purposes, and being proficient in handling these records is a critical aspect of their job responsibilities.

Furthermore, having a working knowledge of typing, Microsoft Office tools, and database management software can be beneficial in the long term. Fortunately, these skills can be taught to new employees with relative ease.

Problem-Solving Skills

Medical coders are responsible for more than just generating bills. They need to leverage their problem-solving skills and communication abilities to navigate interactions with insurers and patients. The primary objective of their job is to expedite payment collection as efficiently as possible. Their role is defined by an unwavering focus on resolving payment-related issues and achieving success in this pursuit.

Insuance companies have to go through the process of submitting, reviewing, and adjusting claims to facilitate payment. However, unlike insurance companies, many patients may not have the financial means to pay their medical bills. In such situations, medical coders should collaborate with patients to determine the most suitable payment plan those benefits both the patient and the organization.

Time Management Skills

The majority of medical coding positions are characterized by a high degree of autonomy. While supervisors may periodically review their work, they typically do not intervene much as long as the work is satisfactory and progressing according to expectations.

Medical coders have a workload that is determined by volume, granting them significant autonomy over their tasks with minimal micromanagement. Therefore, possessing the discipline and motivation to manage time efficiently is crucial for medical coders.

Strong Moral Character

As coders are directly responsible for generating revenue, they must adhere to strict ethical standards to maintain integrity. They handle an organization's confidential medical records regularly and can easily misuse them. Therefore, hiring managers must prioritize moral character as a job requirement to prevent any potential data breaches in the future.

Evaluating a candidate's integrity in a single interview can be challenging for recruiters. Therefore, it is recommended to request references to gain insight into the candidate's ability to handle confidential data appropriately. Medical coders are expected to treat patient data confidentially, avoid any potential conflicts of interest, and follow strict coding standards to avoid any legal repercussions.

The Hidden Benefits of Hiring a Medical Coder: Why Your Practice Needs One

1. Boosting Your Collection Rate

The financial well-being of healthcare practitioners can be significantly impacted by their ability to collect payments from patients. However, the healthcare industry often faces challenges with slow collections. For practitioners with a small staff, managing the filing and tracking of payments from multiple patients can become overwhelming and stressful.

Skilled medical coders can improve the collection rate by minimizing the number of rejected claims and speeding up the payment process. Their accurate documentation and prompt submission of claims can lead to the quicker payment of outstanding patient bills.

2. Enhance your financial stability

Improving the collection rate has a direct impact on enhancing the cash flow, which is a critical aspect of any organization's financial health. A steady cash flow is essential for the smooth running of operations and the growth of the organization.

Medical coders who possess strong attention to detail, expertise in coding software, and knowledge of coding guidelines and medical treatments can boost the profitability of your healthcare practice by accelerating the payment process and improving cash flow.

3. Stay Ahead of the Game

Having higher profitability than your competitors can provide opportunities to enhance the quality of facilities and services in your healthcare organization, giving you a competitive advantage in the market.

Hiring skilled medical coders who can efficiently handle patient collections with precision can give your healthcare practice a competitive edge. With their expertise in claim and patient follow-up, as well as speedy resolution of rejected claims, medical coders can improve the efficiency and accuracy of the collection process, giving you an advantage over other practitioners in the industry.

Crack the Code to Hiring Medical Coders: Follow these steps

Craft a Winning Job Description

To start, craft a job description that clearly defines the responsibilities of the medical coder position. Some offices may only require coding tasks, while others may require the coder to handle the entire claims process, from interpreting provider documentation to billing and denial follow-up.

Seek out experienced coders who fulfill your requirements. It's advisable to recruit a Certified Professional Coder (CPC) who has the necessary experience. Not possessing certification doesn't necessarily imply that the person isn't a competent coder; nevertheless, being credentialed denotes proficiency in fundamental ICD-9, CPT®, HCPCS, medical vocabulary, and anatomy.

It is crucial to consider if the coder has experience dealing with insurance companies since numerous payer-specific regulations and guidelines must be followed. Having a well-defined job description can help in effectively evaluating resumes and asking appropriate questions during the interview process for a potential new hire.

Searching Strategically: Proper Places to Look

Once the job description is clear, the next step is to identify the appropriate channels to advertise the job opening and attract qualified candidates. You can explore different options such as reaching out to local colleges, contacting national credentialing organizations, or posting the job on professional job search websites.

Initially, consider existing staff members who are interested and capable of obtaining a CPC certification before searching outside. These employees are already familiar with your organization, and investing in them can be beneficial.

Obtaining proficiency in coding requires time and practice, but it is a learnable skill. Local colleges that provide degree programs or certification preparation courses in coding and billing are excellent resources for finding capable coders. While some practices may be hesitant to employ fresh graduates due to their lack of experience, recent graduates are typically enthusiastic about learning and have a solid grasp of the fundamentals. Additionally, many newly certified coders already have work experience but have recently pursued additional education.

Don't Just Take Their Word for It: Confirm Their Experience and Credentials

To ensure the competency of your potential coder, test their ability to code real-life scenarios by providing a screening exam. The exam should be based on the cases and scenarios commonly encountered in your practice, requiring accurate selection of ICD-9 or ICD-10 codes, CPT® codes, and HCPCS codes as necessary. The results of the exam will help identify the candidate's strengths and areas for improvement.

The candidate's comprehension of medical vocabulary and anatomy is crucial as coders must be capable of understanding the provider's documentation, which may involve complex terms, abbreviations, and references to anatomy. Consider including a brief terminology and anatomy quiz along with the case scenarios.

Finally, it is important to evaluate the candidate's character. As coders have access to confidential information such as medical records, financials, and personal details, conducting a background check is necessary. This includes contacting the candidate's references, verifying their employment history, and inquiring about their reasons for leaving previous jobs. It is crucial to exercise caution when selecting individuals who will have access to sensitive and private information.

Wrapping

A skilled medical coder not only improves the financial health of your facility but also reduces the risk of liability related to insurance claims. In the healthcare industry, profitability is also very important. When hiring medical coders, it's important to consider it as a strategic investment with potential long-term returns. The correct codes are essential for insurers to process claims accurately, and coders are responsible for resubmitting rejected claims and managing records during audits.

It is crucial to find the appropriate talent in the medical coding and billing field. The individuals you hire will have access to sensitive information, so it's essential to be meticulous in the hiring process and find the best match for your organization.

We provide companies with a comprehensive plan and necessary Assessment to find and evaluate a medical coder, from start to finish. Get in touch with our team of experts to book a call today and hire the best fit.

Taking the upper hand: Crack the Code to Hiring Medical Coders