What Does a Medical Billing and Coder Do?

A medical billing and coder is responsible for translating patient healthcare services into standardized codes and ensuring those codes are submitted correctly to insurance companies for reimbursement. Their work ensures healthcare providers get paid accurately and promptly while minimizing billing errors and compliance risks.

Medical billing and coding professionals are essential to the revenue cycle of any medical facility, working behind the scenes to connect clinical care with financial systems. Their role combines healthcare knowledge with administrative and technical expertise.

Understanding the Core Responsibilities of a Medical Billing and Coder

Medical billing and coding may sound like a single job, but it includes two distinct functions—medical coding and medical billing—that often work hand in hand.

1. Medical Coding Duties

Medical coders read and analyze patient records, then assign specific alphanumeric codes based on:

• Diagnosis (ICD-10 codes)

• Procedures (CPT/HCPCS codes)

• Medical equipment or supplies

These codes are universally recognized in the healthcare industry and are used by insurance providers to determine coverage and reimbursement amounts.

2. Medical Billing Duties

Medical billers use the codes provided by coders to prepare insurance claims and submit them to payers. Their responsibilities include:

• Verifying patient insurance coverage

• Creating accurate claims based on coded data

• Submitting claims electronically

• Following up on unpaid or rejected claims

• Managing patient billing and payment records

A medical billing specialist acts as the bridge between the healthcare provider, insurance company, and patient.

Key Skills Required for Medical Billing and Coding

To perform these duties efficiently, medical billers and coders must be detail-oriented and possess:

• A strong understanding of medical terminology and anatomy

• Proficiency in billing software and electronic health records (EHR)

• Knowledge of HIPAA and other healthcare compliance regulations

• Analytical thinking and error-checking skills

• Communication skills for insurance follow-ups and provider coordination

Where Do Medical Billers and Coders Work?

They work in various healthcare settings including:

• Hospitals and clinics

• Private physician offices

• Medical billing service companies

• Insurance firms

• Long-term care facilities

• Remote/home-based roles (increasingly common with telehealth)

Importance of Medical Billing and Coding in Healthcare

Accurate billing and coding are critical for:

• Timely reimbursement to healthcare providers

• Reducing billing errors and claim denials

• Ensuring compliance with government regulations

• Streamlining the patient experience

Incorrect coding can lead to financial loss for providers and legal complications due to non-compliance.

How EZ Settle Solutions Can Help

At EZ Settle Solutions, we specialize in outsourced medical billing and coding services tailored to help clinics and practices reduce administrative burdens and maximize revenue. With a team of certified professionals, we ensure every claim is coded correctly and submitted efficiently—so you can focus on patient care while we handle the backend seamlessly.