Most of the transactions and payments processed by a hospital or clinic do not involve direct payments from patients. Rather, these institutions rely on payments from private and public insurance companies. The key to making these transactions run smoothly is having procedures, referrals, and lab work properly coded and classified so that insurers pay promptly. While an individual doctor’s office in a smaller practice may delegate this responsibility to an office manager, larger clinics or hospitals often hire certified medical coders (CMCs) to perform this work.
The CMC (in certain jurisdictions, the title may be certified professional coder, CPC, or certified coding specialist, CCS) works in data entry to classify and code the various examinations, lab work, surgeries, and other procedures performed by their institution. Every healthcare service performed and product dispensed carries an accompanying code that must be accurately entered into a billing system. The CMC then works to ensure that invoicing is properly handled so the insurer receives a properly coded and itemized bill and so the patient is kept abreast of billing, necessary co-pays, and needed deductibles.
To work as a CMC, an associate’s degree or other education from a vocational school is generally needed. Then, the individual must pass any required certification testing. A new CMC may work either at a smaller clinic or in a lower position in data entry at a hospital to earn the requisite practical experience to be considered for more lucrative jobs in this field. CMCs typically work at a computer in an office environment during regular business hours.
Certified Medical Coder (CMC) Tasks
Protect the security of medical records to ensure that confidentiality is maintained.
Identify, compile and code patient data, using ICD-9-CM and CPT and other standard classification coding systems.
Enter data, such as history and extent of disease, diagnostic procedures and treatment into computer database.
Compile, abstract and maintain patient medical records to document condition and treatment.
Review records for completeness, accuracy and compliance with regulations.