Day in the life
A Day in the Life of a Medical Billing and Coding Specialist
What medical billing and coding specialists actually do from the start of a shift to the end: the tasks, tools, schedule and realities of the job.
Log into the encoder and EHR from home and pull the queue of yesterday’s outpatient visits. From there, the day usually includes review physician notes, operative reports and other documentation, assign ICD-10-CM diagnosis codes and CPT/HCPCS procedure codes, and apply modifiers and check codes against payer and NCCI edits. Usually full-time weekday hours. Remote and flexible schedules are common once you have experience and meet productivity and accuracy standards.
Hour by hour: a typical shift
No two days are identical, but this timeline reflects a realistic day for a medical billing and coding specialist working full time.
- Log into the encoder and EHR from home and pull the queue of yesterday’s outpatient visits.
- Code office visits, choosing the evaluation and management level supported by the documentation.
- Send a provider query asking whether a diagnosis was acute or chronic.
- Review the clearinghouse rejection report and fix a missing modifier and an invalid diagnosis pointer.
- Work denials: appeal a medical-necessity denial with supporting documentation.
- Post insurance payments from electronic remittance advice and flag underpayments.
- Complete a coding education module on this year’s code updates.
Where medical billing and coding specialists work
Medical billers and coders work for hospitals, physician practices, billing companies, insurance companies and outsourcing firms. The work is computer-based and sedentary. Many experienced coders work remotely full time.
Hours and schedule
Usually full-time weekday hours. Remote and flexible schedules are common once you have experience and meet productivity and accuracy standards.
Tasks you’ll do most often
- Review physician notes, operative reports and other documentation
- Assign ICD-10-CM diagnosis codes and CPT/HCPCS procedure codes
- Apply modifiers and check codes against payer and NCCI edits
- Prepare and submit claims electronically through a clearinghouse
- Post payments and review explanations of benefits
- Investigate and appeal denied or underpaid claims
- Query providers when documentation is unclear and protect patient privacy
Tools you’ll use every day
- Encoder software such as 3M or Optum EncoderPro
- EHR systems such as Epic or athenahealth
- Practice management and billing systems
- Claims clearinghouses
- ICD-10-CM, CPT and HCPCS code books
- Spreadsheets for tracking A/R and denials
The best and hardest parts of the job
What people like
- No patient contact or blood: healthcare from behind a desk
- Strong remote-work potential after experience
- Certificate programs take months, not years
- Clear certifications and specialties raise pay
What’s hard
- Highly detail-oriented and repetitive
- Productivity and accuracy quotas
- Annual code changes require continual learning
- Entry-level coding jobs often require experience: billing can be the door in
You’ll likely thrive if…
- I enjoy detailed, accurate work at a computer
- I want a healthcare job without patient contact
- I can stay focused and productive on my own
- I like learning rules and applying them precisely
- I’m interested in medical terms and how the body works
- Remote work in the future appeals to me
Not sure? Take the free Medical Billing and Coding Specialist fit quiz or the Career Match Quiz.
Staying safe on the job
- Protect patient information under HIPAA: access only what you need for your job
- Never upcode or bill for services not documented; this can constitute fraud
- Lock your screen and secure your home workspace if remote
- Report suspected compliance problems through proper channels