What It’s Like to be a Health Claims Specialist

A look inside the interesting profession of medical billing and coding

For anyone looking at medical billing and coding training, it’s a good idea to think about your future career. What kinds of things will you do in a typical day on the job? What will be expected of you in this career? What is the work environment like? To get an understanding of these questions and more, take a peek into a typical “Day in the Life” of a Health Claims Specialist.

Getting your morning started

Most medical billing and coding jobs take place in an office setting. It is likely you will have a desk or a cubicle where you will spend most of your day. To get started each morning, you will have a seat at your desk and log into your organization’s computer network. There you will find a list of patient charts that you need to review that day.

If you are a medical coder, your job will be to assign the appropriate codes to each patient chart. The codes identify what diagnoses were made and what procedures were provided for the patient. If you are a medical biller, your job will be to make sure the charts have been coded correctly and then to submit insurance claims to Medicaid, Medicare, or private insurers.

To do this, you will use the coding systems that you learned during your medical billing and coding training: The International Classification of Diseases (ICD-10) and Current Procedural Terminology (CPT), and the Healthcare Common Procedure Coding System (HCPCS).

The ups and downs of your day

Going through your list of patient charts each day can have its ups and downs. Many of the charts will be easy to code. They might have common procedures or frequent diagnoses in them, and you will quickly know what codes to use. For charts like these, you can easily enter in the right codes, and move on to the next chart on your list.

But they won’t all be this easy. Most days you will find harder cases where you aren’t sure what to do. You may need to do extra research or consult with a more experienced coder to find out the best codes to use for a specific record. Or you might find that a chart is missing some documentation altogether, and that you need to go back to the doctor or nurse to get the right information.

With the relatively new ICD-10 system, there are over 68,000 codes, and many coders are still getting familiar with them. It may be a challenge to find the right code, but you will get better at it. Some cases may take longer and feel a little frustrating, but most health claims specialists agree that there is something satisfying about the “detective work” they need to do to solve a complicated coding issue.

Where you work

Every medical coding job is slightly different, but generally you will find that these professionals work at a desk, cubicle, or a shared space. You will spend much of your day on the computer. In bigger practices, you may have two computer monitors to help you be more efficient in your work. You can keep the patient charts open on one monitor, while you use the other screen to do research and look up codes.

Expect to be challenged in your job. In a large medical practice, you may have a quota for the number of charts you must complete each day, so be prepared to work quickly and efficiently. And remember, above all, accuracy in coding is very important!

Your fellow employees

Depending on the facility where you work, you could be working with dozens of other coders, or perhaps just a few. Large hospital systems need more staff to handle the coding and billing needs, and may have an entire department dedicated to it. This can be a great benefit, because there will be other billers and coders to learn from.

Smaller doctors’ offices may need just one or two medical coders on staff, and you may end up working alongside other professionals such as medical assistants and administrative assistants, and feeling part of the whole healthcare team.

We hope this article has helped you get a feel for this interesting profession. Still have questions about this career field? For more information, see 5 Things to Know About Being a Medical Biller or Coder.

The Harris School of Business provides career training for medical billing and coding careers in our Health Claims Specialist Plus program. Choose from our locations in Pennsylvania, New Jersey, and Delaware. Contact us today, and find out if this is the right program for you.