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Medical Biller and Coder Certification in California. Why is it Important?

AHIMA logo, AAPC logo, and a Medical Billing and Coding student at a computer.
While certification is not required for Medical Billers and Coders in California, it’s a great way to get ahead

Ever wondered if you need to be certified to work as a Medical Biller or Coder? Medical Billing and Coding students have several options when it comes to certification in the state of California. There are a few accrediting agencies that are nationally accepted that offer certification exams which students may sit for. We will go over each exam and the agency that offers it. Becoming certified shows employers that you are knowledgeable in Medical Billing and Coding procedures and you are competent to work as a Medical Biller or Coder.

Although certification is not required by law in the state of California, it may be beneficial for career advancement purposes. Generally, certified Medical Billers and Coders earn more when compared to noncertified Medical Biller and Coders. If you would like to learn more about Medical Biller and Coder Certification in California then continue reading.

Medical Billers

According to the American Academy of Professional Coders or AAPC, “Medical billing is the process of submitting and following up on claims with health insurance companies in order to receive payment for services rendered by a healthcare provider.” A knowledgeable Medical Biller is an asset to a medical practice because they can increase revenue by ensuring claims are being submitted in a timely manner according to specific insurance carrier guidelines, correctly without error to prevent rejections, and followed closely to ensure the practice receives reimbursement for work a provider(s) perform.

Medical Billers can work for insurance companies, clearinghouses, hospitals, private physician offices, and clinics. They generally work in an office environment, handling insurance claims, making phone calls to insurance companies, and contacting patients with billing questions or concerns. Medical Billers are important because the financial health of a practice depends heavily on the performance of the Medical Billing department. Practices struggling with decreasing revenue will require highly skilled Medical Billers that understand medical insurance and the appeals process. How to obtain Medical Biller credentials will be discussed later in the article.

Medical Coders

According to the American Academy of Professional Coders or AAPC, “The main task of a medical coder is to review clinical documentation written by the physician and then to translate the medical services and procedures, diagnoses, and equipment and supplies into CPT®, ICD-10-CM, and HCPCS Level II codes.” Medical Coders are experts in Anatomy and Physiology, Medical Terminology, insurance processes, and translating medical records or a physician’s documentation into alphanumeric codes. They are a vital part of the revenue cycle that allows a medical practice to get paid for office visits, surgeries, diagnostic tests, etc., provided by a medical facility.

A skilled Medical Coder can identify billable services from various types of medical documents and code them to the highest level of specificity. Those codes are then sent to the billing department where they will be submitted to an insurance company for payment. Medical Coders are important because they provide a service that requires a comprehensive knowledge and continued education in HIPAA or Health Insurance Portability and Accountability Act laws, coding guidelines, filling limitations and deadlines, and continuing credits related to licensing requirements. How to obtain Medical Coding credentials will be discussed later in this article.


Medical Biller Certification

Medical Billers are not required to be licensed to work in the state of California, but there are advantages to obtaining a Medical Biller Certification. Medical Billers are responsible for creating, submitting, appealing, and following up with insurance claims for reimbursement purposes. Their work is important for a medical practice to be successful.

Although Medical Billers are not required to become certified, earning one of the following certifications will give you the edge to stand out among your competitors. Having some training and experience in Medical Billing will give you the confidence to work with other seasoned Medical Billers. With that being said, there are a few Medical Biller exams students can earn through two well recognized accrediting agencies to become a certified Medical Biller which may include, but not limited to:

AAPC or The American Academy of Professional Coders Medical Billing Certification Exam

  • CPB or Certified Professional Biller

AMBA or The American Medical Biller Association

  • CMRS or Certified Medical Reimbursement Specialist

Medical Coder Certification

Medical Coders are not required to be licensed in the state of California. Many employers prefer or require potential employees to have a Medical Coder license by a nationally recognized accrediting agency. There are two accrediting agencies that are considered the gold standard for Medical Coding certification which include; AAPC also known as The American Academy of Professional Coders and AHIMA also known as American Health Information Management. Both agencies offer Medical Coding certification.

Students may study independently, complete a Medical Coding Program, or complete Medical Coding courses offered directly through either of these accrediting agencies. If students feel well prepared and ready to sit for any one of these licensing examinations, they may do so through either AAPC or AHIMA. Obtaining Medical Coding credentials shows employers you have the knowledge and training to work as a Medical Coder. Here are a few credentials that a Medical Coder can earn which may include, but is not limited to:

AAPC Medical Coding Certification Exams

  • CPC or Certified Professional Coder
  • COC or Certified Outpatient Coder
  • CIC or Certified Inpatient Coder
  • CRC or Certified Risk Adjustment Coder
  • Specialty Medical Coding (offered to experienced Medical Coders)

AHIMA Medical Coding Certification Exams

  • CCA or Certified Coding Associate
  • CCS or Certified Coding Specialist
  • CCS-P or Certified Coding Specialist-Physician Based

For additional information on Medical Coder examination requirements, continuing education, exam fees, and eligibility please visit the official AAPC and AHIMA website.

Interested in Becoming a Medical Biller and Coder?

After learning about the different certifications available to Medical Biller and Coders and their importance are you ready to start a career as a Medical Biller and Coder? The field of Medical Billing and Coding offers individuals the flexibility and career advancement opportunity you may not find in another profession. You have the option to work from home, off on the weekends, and you as you gain experience you can earn additional certifications.

An experienced Medical Biller and Coder is a hot commodity to a medical practice because you can prevent losses in revenue by being thorough and accurate when submitting insurance claims. If you are interested in becoming a Medical Biller and Coder then visit and speak with an admissions representative to get started today!

Is a Rewarding Career in Medical Billing and Coding Right for You? Get More Info…

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