The healthcare industry is dynamic, complex, and constantly evolving to meet the needs of patients, families and communities served. When exploring careers within this exciting field, you will quickly realize there are MANY rewarding, interesting, and fulfilling paths to consider.
Long gone are the days where an interest in healthcare meant having to only choose between becoming a doctor or nurse. Quite the opposite! In an effort to pivot alongside an emerging consumerism-based environment, there has been a marked increase in professional, non-clinical roles that are essential to a care facility and/or organization’s long-term success.
Valued Team Members
Certified Billing and Coding Specialists (CBCS) are valued team members within a healthcare business ecosystem. They are primarily responsible for ensuring the accuracy and safeguarding of medical information, translating diagnosis and treatments using standardized coding practices, and facilitating adequate claim processing and payment.
CBCS professionals are responsible for upholding patient safety and privacy, making them critical members of the interdisciplinary care team. A CBCS may have direct interaction with patients and family members, as seen in many Billing roles. Therefore, alongside mastering billing knowledge and related technical skills, a CBCS must be able to effectively demonstrate active listening, empathetic communication and service recovery to uphold patient and family centered care.
A Holistic Approach
NHA believes in empowering healthcare professionals to pursue and achieve their career goals and aspirations. That’s why, beginning this summer, we are expanding CBCS education and certification prep to best align with current industry trends. In addition to receiving a solid foundation in medical billing and coding, there will be an added component focused on revenue cycle and regulatory compliance.
Why the change and why now? The Healthcare Financial Management Association defines revenue cycle as “all administrative and clinical functions that contribute to the capture, management, and collection of patient service revenue1.”
Similar to a three-legged stool, each domain - billing, coding, and revenue cycle - compliment and is heavily reliant on the other. They go hand-in-hand. Although each particular facet may have a specific focus, they are completely interdependent and contribute to an overarching business strategy.
"Similar to a three-legged stool, each domain - billing, coding, and revenue cycle - compliment and is heavily reliant on the other. They go hand-in-hand."
As reimbursement models continue to transform due to legislature, insurance policies and/or healthcare reform measures, providers and organizations must remain vigilant and flexible.
In reflecting on this reality, emerging CBCS professionals must therefore be prepared, well-rounded, and knowledgeable across all revenue cycle areas. And so, instead of viewing particular functions within a vacuum or silo, this comprehensive approach offers CBCS professionals a truly integrated and holistic skillset and perspective.
Becoming a Certified Billing and Coding Specialist requires dedication and focus. The exam is created to test against numerous topics, tasks, and applied knowledge scenarios. Having that added focus on revenue cycle is extremely beneficial when preparing because of how its core concepts tie seamlessly into all of the exam components. Below outlines major test domains:
- Revenue Cycle and Regulatory Compliance – examining revenue cycle phases and interdependencies; comprehending relevant laws, policies, and requirements related to billing and coding roles
- Insurance Eligibility and Payer Requirements – verifying patient insurance information to determine benefits, applicable copayments, deductibles and/or co-insurance dues
- Coding and Coding Guidelines – leveraging knowledge of anatomy, physiology, and medical terminology to accurately identify and apply codes using approved code sets/manuals/guidelines (i.e., ICD-10-CM, CPT®, HCPCS)
- Billing and Reimbursement – understanding the life cycle of claims, deciphering payer responsibility (patient or third-party payers), coding sequencing for optimal reimbursement, and trouble-shooting reconsideration and/or appeals processes
CBCS Career Opportunities
In healthcare, revenue cycle is a highly prioritized department and function as it impacts operations and finance. We are confident that by focusing on billing, coding and revenue cycle that our CBCS professionals will receive quality education, optimal certification test prep and be set-up for career success.
Achieving CBCS credentials is a major milestone in kick-starting a career in healthcare. There is ongoing demand for these roles across the continuum of care as seen within hospitals, doctor’s offices, community clinics, care facilities, and insurance companies.
CBCS roles can offer stability, competitive pay and benefits, flexible hours, work-life balance, and various work environments (office or at-home). Additionally, if management and leadership are of interest, this specialty can also offer great opportunities to grow and develop. When one leads with enthusiasm, professionalism, integrity, and commitment to positively contribute to caring for others, the possibilities are truly endless.
- com (2019). What is Revenue Cycle in Healthcare? Accessed via https://www.healthstream.com/resources/blog/blog/2019/04/08/what-is-revenue-cycle-in-healthcare