Key Points

• Role Definition: A medical biller and coder is a healthcare professional who translates patient diagnoses, treatments, and procedures into standardized codes to facilitate accurate billing and insurance claims.
• Path to Entry (Colorado): How do you become one? – Generally by finishing high school, completing a medical billing and coding training program (often under 1 year), and obtaining a recognized certification like the CPC or CCS.
• Training Duration: Most medical billing and coding programs take 6 to 12 months to complete (certificate programs), though pursuing an associate degree can take up to 2 years.
• Average Salary in Colorado: Medical billers and coders in Colorado earn about $59,000 per year on average.
• Employment Outlook: Approximately 1,800 people work as medical records specialists (billers/coders) in Colorado. Employment is projected to grow ~9% from 2023 to 2033, faster than the average for all jobs!

What is a Medical Biller and Coder?

A Medical Biller and Coder is a professional who handles the financial and records side of healthcare. In one sentence: They ensure healthcare services are coded and billed properly so that providers are reimbursed and patient records stay accurate. This role combines knowledge of medical terminology, coding systems, and insurance processes.

Medical billing and coding are technically two functions often performed by the same person (especially in smaller facilities):

• Medical Coding: This involves reviewing clinical documentation and assigning universal codes (such as ICD-10-CM for diagnoses, CPT/HCPCS for procedures) to represent every diagnosis, treatment, or service a patient receives.
• Medical Billing: This involves using those codes to prepare insurance claims and patient bills, then submitting them to insurance companies (or patients) for reimbursement. A biller follows up on claims, resolves any discrepancies or denials, and ensures the healthcare provider gets paid the correct amount.

In many Colorado healthcare settings, one person is trained to do both coding and billing tasks. No matter the job title, the primary goal is the same: translate healthcare services into standardized data and dollars.

What Does a Medical Biller and Coder Do?

Medical billers and coders handle a variety of important tasks behind the scenes in clinics, hospitals, and insurance offices. Their work ensures that billing is accurate and patient records are up-to-date.

Key responsibilities include:

• Reviewing Patient Information: They go through patient charts and medical records to verify diagnoses, treatments, and any pre-existing conditions relevant for billing.
• Assigning Codes: Using classification systems (ICD-10 for diseases, CPT/HCPCS for procedures), they convert each service and diagnosis into the appropriate medical code. For example, a routine check-up, an x-ray, and a lab test each get specific codes.
• Processing Claims: Medical billers and coders are responsible for processing patient data and submitting insurance claims based on those codes. They prepare claim forms or electronic submissions to insurance companies (or government payers like Medicare/Medicaid), ensuring all information is correct and compliant with insurance requirements.
• Resolving Billing Issues: They act as a liaison between the healthcare provider and the payer. If a claim is denied or if more information is needed, billers/coders follow up to resolve discrepancies, resubmit claims, or arrange payment plans.
• Maintaining Records: In addition to billing, they update and maintain electronic health records (EHR) and billing databases. They must ensure patient data privacy (following HIPAA regulations) and keep records organized for audits and future reference.

Requirements to Become a Medical Biller and Coder in Colorado

One benefit of this career is the relatively accessible entry requirements. Colorado, like most states, does not have strict licensing for medical billers and coders, but there are important qualifications and credentials that employers look for:

• Education: At minimum, you need a high school diploma or GED. This is required for almost any training program or entry-level job. High school courses in biology, computer science, or health can be helpful. Beyond high school, most employers prefer some postsecondary education in medical billing/coding. Community colleges and technical schools in Colorado offer certificate programs (typically 6–12 months) and associate degrees (around 2 years) in Health Information Technology or Medical Billing and Coding.
• Certification (National): Colorado does not require a state license for medical billing or coding. However, professional certification is highly recommended and often expected by employers. Two of the most recognized certifications are the Certified Professional Coder (CPC) from AAPC and the Certified Coding Specialist (CCS) from AHIMA, which prove your expertise in coding standards. Other credentials include CCA, CBCS, or RHIT.
• Skills: You should be comfortable with technology (most work is on computers using EHR systems and billing software) and have a keen eye for detail. Strong organizational and communication skills are important since you’ll be interacting with healthcare staff and insurance companies to address billing questions. An understanding of medical terminology and basic anatomy is crucial, which is why training programs focus on these topics.
• Background Checks/Other Requirements: While not a formal state requirement, note that many employers (especially hospitals) may require a background check, proof of certain vaccinations, or drug testing as part of hiring, given the sensitive nature of health information. Additionally, maintaining patient confidentiality is a must – you’ll likely undergo HIPAA compliance training either during your program or on the job.

How to Become a Medical Biller and Coder in Colorado

Step 1: Meet Basic Requirements

1. High School Diploma or GED
   • This is the minimum requirement for most entry-level jobs and training programs.
2. Technology and Communication Skills
   • Comfort with computers and medical software is key. Clear communication helps when interacting with insurance companies and healthcare staff.

Step 2: Complete a Billing/Coding Program

• Certificate or Diploma Programs (6–12 months):
  • Short, focused programs that teach core coding systems (ICD-10, CPT) and billing procedures. Ideal if you want to enter the workforce quickly.
• Associate Degree Programs (18–24 months):
  • More comprehensive courses, including general education classes. Earning a degree can lead to advanced roles or easier credit transfer if you pursue further education.

Platforms like Dreambound list schools and programs offering medical billing and coding classes in Colorado. For instance, you can find:

• Medical Billing Training in Denver, CO

Step 3: Consider National Certification

Though Colorado law does not mandate certification, many employers prefer or require it:

• Certified Professional Coder (CPC) – Offered by the American Academy of Professional Coders (AAPC).
• Certified Coding Specialist (CCS) – Granted by the American Health Information Management Association (AHIMA).

Certification Exam Tips

1. Review Eligibility: Check experience or coursework prerequisites on the AAPC or AHIMA websites.
2. Study Materials: Take advantage of official study guides, practice exams, and online classes.
3. Exam Day: Be punctual. Bring valid ID and any required documents. Expect multiple-choice questions on medical terminology, coding guidelines, and billing processes.
4. Maintain Your Credential: Most certifying bodies require continuing education units (CEUs) to stay updated with industry changes.

Step 4: Start Your Job Search

Once you have your training (and optional certification):

1. Create a Resume/Cover Letter

   • Emphasize coursework, externships, or hands-on experience.

2. Network Online and Offline

   • Join Colorado-specific healthcare groups on LinkedIn.
   • Attend local AAPC chapter events or job fairs.

3. Apply for Positions

   • Check hospital or clinic websites, job boards, and local staffing agencies.
   • Use resources like MyNextMove.org to explore medical billing and coding career paths, see job outlooks, and find relevant opportunities near you.

4. Interview Prep

   • Be ready to answer scenario-based questions (e.g., how to handle denied claims or ensure coding accuracy).