Medical billing questions

What does a medical biller do?

A biller takes the codes assigned by a coder, together with the patient's demographic and insurance details, and builds a claim. The biller then:

• submits claims to insurers, usually electronically;
• tracks payments and reads remittance advice;
• works denials and files appeals;
• bills patients for their share, and answers their questions;
• posts payments and follows up on unpaid accounts.

See the billing and coding cycle for how these steps fit together.

How is billing different from coding?

Coders translate documentation into diagnosis and procedure codes (ICD-10-CM, CPT® and HCPCS Level II). Billers use those codes to get the claim paid. In small practices one person often does both. Larger organisations usually separate the roles. See medical coding questions.

What do billers need to know?

• Enough medical terminology and coding to read a claim and spot errors
• How Medicare, Medicaid and commercial plans pay, including coverage and prior authorisation rules
• Claim forms and electronic claim submission
• Denial management and appeals
• Patient privacy under HIPAA
• Basic accounting and good communication

What education is required?

There is no single legal standard. According to the Bureau of Labor Statistics, medical records specialists, the federal category that includes coders, typically enter with a postsecondary certificate, although some qualify with a high school diploma. Billing roles vary widely: small offices may hire for experience, while larger organisations often ask for formal training or a credential.

Which billing certifications exist?

AAPC's Certified Professional Biller (CPB) is a widely known billing credential. Its exam has 135 questions in four hours, and AAPC lists it among its core exams ($425 for one attempt, $499 for two). AHIMA's credentials, such as the RHIT, are broader health-information credentials that include revenue-cycle work. See medical billing certification.

Where do billers work?

Physician practices, hospitals, billing companies, insurers and other payers. Many billing roles can be done remotely once you have experience.

What do billers earn?

BLS does not publish a separate figure for billers. For medical records specialists, the closest federal category and the one that includes medical coders, it reports a median annual wage of $51,140 in May 2025. Pay varies with location, credential, experience and employer.