How to Become a Medical Biller and Coder: Steps, Skills and Pay
Coders turn chart notes into ICD and CPT codes; billers chase the claims those codes produce — here's how the training, exams and shifts work.
By Ananya Rao · Oct 15, 2026 · 14 min read
Most people enter medical billing and coding through a postsecondary certificate program rather than a four-year degree, then sit a coding credential exam and apply for entry-level records, coding or billing jobs. The U.S. Bureau of Labor Statistics (2025) lists the typical entry-level education for medical records specialists as a postsecondary nondegree award, with no related work experience and no on-the-job training required.
Expect roughly four months to a year of training, a few hundred dollars in exam fees, and a first job where accuracy targets matter more than speed on day one. What you earn afterwards depends heavily on setting, specialty and credentials.
What a medical biller and coder does
Coding and billing are two halves of the same revenue cycle. Coders translate what happened in the exam room or operating theatre into standard codes; billers turn those codes into a claim and chase it until it pays. In small practices one person does both. In hospitals they are usually separate jobs on separate teams.
A typical day includes:
- Reviewing patient records for timeliness, completeness and accuracy, and sending a query back to the clinician when the note doesn't support the code you would otherwise assign (U.S. Bureau of Labor Statistics, 2025).
- Assigning diagnosis and procedure codes using classification systems, for patient care, population health statistics and billing (U.S. Bureau of Labor Statistics, 2025).
- Acting as the liaison between healthcare providers and the billing office when a code, a modifier or a missing signature is holding up a claim (U.S. Bureau of Labor Statistics, 2025).
- Recording data electronically and maintaining and retrieving records for insurance reimbursement and data analysis (U.S. Bureau of Labor Statistics, 2025).
- Working denials and rejections on the billing side: reading the payer's reason code, correcting or appealing, and resubmitting. Whether this sits in your job description depends on the employer.
- Protecting the confidentiality of patients' records, which in practice means minimum-necessary access, locked screens and audit trails you can be asked about (U.S. Bureau of Labor Statistics, 2025).
- Posting payments and reconciling remittances against what was billed, in practices where billing and coding are combined.
Where the jobs are. In 2025 the largest employers of medical records specialists were hospitals (28%), offices of physicians (18%), professional, scientific and technical services (10%), administrative and support services (8%) and management of companies and enterprises (7%) (U.S. Bureau of Labor Statistics, 2025). That last group includes billing companies and outsourced coding vendors, which is where a lot of remote work sits.
Schedule. Most medical records specialists work full time, and in facilities that are always open, such as hospitals, you may work shifts including nights or weekends (U.S. Bureau of Labor Statistics, 2025). Clinic and billing-company roles are more often standard weekday hours.
The honest part. It is sedentary, screen-bound, measured work. Most employers set productivity expectations — charts or claims per hour — alongside an accuracy threshold, and the two pull against each other. Coding is also audited: your work gets reviewed, errors get listed, and you explain them. If being graded on precision every month would wear you down, this is the wrong job. The volume of denial work in billing roles can also be relentless in specialties with complicated prior-authorisation rules.
How to become one
- Confirm your high school diploma or GED is in hand. AHIMA requires a high school diploma to sit the Certified Coding Associate (CCA) exam (AHIMA, undated), and survey respondents for this occupation said a high school diploma or equivalent is required for new hires in 52% of cases, a post-secondary certificate in 22%, and some college without a degree in 13% (O*NET OnLine, U.S. Dept. of Labor, undated). Time: none if you already have it.
- Enrol in a coding certificate program that covers anatomy and physiology, medical terminology, and basic ICD and CPT coding. AHIMA recommends completion of an AHIMA-approved coding program (PCAP), or other training covering those subjects, before sitting the CCA (AHIMA, undated). Time: roughly 4–12 months depending on full- or part-time study. Cost varies widely between community colleges, hospital-run programs and private online providers, and by state — ask the school's financial aid office for the total including books and software access before you enrol.
- Code practice charts until it is boring. Work through de-identified or instructor-supplied encounters and keep a log of 50–100 coded cases across at least two specialties, noting the code, the supporting documentation line, and why you rejected the near-miss code. Time: 2–4 months alongside coursework. Cost: usually included in your program; standalone coding practice books add a modest amount.
- Get hands-on with encoder and grouper software. Categorization and classification tools used in this occupation include 3M Encoder, American Medical Association CodeManager and DRG grouping software (O*NET OnLine, U.S. Dept. of Labor, undated). Ask your instructor which your program licenses and how long your student access lasts. Time: a few weeks of regular use.
- Choose and book one credential, not three. The CCA exam costs $199 for AHIMA members and $299 for non-members, with retake fees the same as the exam cost (AHIMA, undated). Third-party guides report AAPC's Certified Professional Coder (CPC) exam at $375–$399 for one attempt or $475–$499 for a two-attempt bundle, with required AAPC membership at roughly $157–$222 a year — figures reported by a third-party source rather than confirmed on AAPC's own site, so check current pricing with the body directly before you pay (Superprof, citing AAPC pricing, undated). Time: 2–4 months of exam prep.
- Sit the exam and plan for the possibility of a retake. The 2025 first-time tester pass rate for the CCA exam was 62%, and as of 31 December 2025 there were 7,753 certified CCA professionals (AHIMA, 2025). Budget the retake fee in advance so a fail is a scheduling problem rather than a financial one. Time: one exam day, plus 4–8 weeks if you resit.
- Build demonstrable EHR exposure. Medical software used in this occupation includes Epic Systems — listed as an In-Demand Hot Technology — along with MEDITECH and eClinicalWorks EHR software (O*NET OnLine, U.S. Dept. of Labor, undated). If your program offers sandbox access, finish every module; if not, front-desk, scheduling or registration work in a clinic puts a named system on your resume. Time: 3–12 months if you take a clinic job to get it.
- Apply to the roles that actually hire beginners and talk to a HIM director. Entry titles include medical records clerk, coding assistant, patient account representative and billing specialist. Employers may prefer to hire specialists who have certification, or may expect applicants to earn it shortly after being hired (U.S. Bureau of Labor Statistics, 2025), so apply while you are studying rather than after. Ask the health information management director at a local hospital what they look for in a first-year coder — that conversation tells you more about your market than any job board. Time: 1–4 months of applications.
Skills you'll need
Hard skills
- ICD diagnosis coding and CPT/HCPCS procedure coding. This is the core of the job: assigning clinical codes using classification systems for care, statistics and billing (U.S. Bureau of Labor Statistics, 2025). Guidelines change annually, so build the habit of reading updates rather than coding from memory.
- Encoder and grouper software. Be able to say which you have used — examples in this occupation include 3M Encoder, American Medical Association CodeManager and DRG grouping software (O*NET OnLine, U.S. Dept. of Labor, undated). Inpatient roles lean on grouping logic far more than outpatient ones.
- Electronic health record navigation. Epic Systems is listed as an In-Demand Hot Technology for this occupation, alongside MEDITECH and eClinicalWorks EHR software (O*NET OnLine, U.S. Dept. of Labor, undated). Knowing where the operative report, pathology result and discharge summary live in a given system is half of coding speed.
- Medical terminology, anatomy and physiology. AHIMA names these as subjects your coding training should cover (AHIMA, undated). You cannot code an operative note you cannot read.
- Claims and denial workflow. On the billing side: clean-claim submission, reading remittance advice, identifying the denial reason, and appealing with documentation. Spreadsheets for tracking aged accounts are a daily tool in small practices.
Soft skills
Reading Comprehension, Critical Thinking, Active Listening, Speaking and Writing are the essential skills listed for this occupation (O*NET OnLine, U.S. Dept. of Labor, undated). Show them like this:
- Reading comprehension — in an interview, walk through a chart you coded where the diagnosis in the assessment contradicted the body of the note, and explain which you followed and why.
- Critical thinking — describe a time you declined to assign a higher-paying code because the documentation did not support it. Employers want to hear that boundary stated plainly.
- Speaking and active listening — physician queries are the job's social core. Be ready to describe how you would ask a busy surgeon for clarification without implying the note was wrong.
- Writing — keep a sample query you have drafted, anonymised. Clear, neutral, specific queries are a skill hiring managers can assess in thirty seconds.
Physician query, sample wording
Dr [Name] — the [date] note for [patient identifier] documents [finding] and treatment with [medication]. Could you clarify whether this reflects [condition A] or [condition B], or another diagnosis, so the record reflects the care provided? No response needed beyond an addendum to the note.
Pay and outlook
Medical records specialists had a median annual wage of $51,140, or $24.59 an hour, in May 2025 (U.S. Bureau of Labor Statistics, 2025). A median means half earned more and half less, and the spread in this field is wide.
What moves you within that spread is mostly setting and specialty. Hospital inpatient coding — where you are assigning DRGs from long, complex charts — generally sits above outpatient clinic coding, which generally sits above straightforward front-office billing. Surgical, oncology and other documentation-heavy specialties pay for the expertise they demand. Credentials matter because employers may prefer to hire specialists who have certification, or expect applicants to earn it shortly after being hired (U.S. Bureau of Labor Statistics, 2025); auditing and clinical documentation credentials usually carry more weight than a first coding certificate. Geography matters a great deal: wages vary by state and metro area, and remote roles are often benchmarked to the employer's location rather than yours. Contract and per-chart arrangements through billing companies can pay differently again, and shift the risk of slow weeks onto you.
On demand: employment of medical records specialists is projected to grow 8% from 2025 to 2035, with about 14,000 openings projected each year on average (U.S. Bureau of Labor Statistics, 2025). Hospitals and physicians' offices together employed the largest share of the workforce in 2025, at 28% and 18% respectively (U.S. Bureau of Labor Statistics, 2025), so the number of claims those settings generate drives most hiring.
The honest counterweight: computer-assisted coding tools now pre-suggest codes in many large systems, which shifts the work towards reviewing, correcting and auditing software output rather than coding from scratch. Some employers also route high-volume outpatient coding to offshore or vendor teams. Neither removes the job, but both reward coders who move towards complex inpatient work, auditing or documentation improvement and penalise those who only do simple, repetitive charts. Many fully remote postings also ask for one to two years of production coding experience, so your first role is more likely to be on-site or hybrid.
Check current numbers yourself rather than trusting a figure in any article, including this one. The BLS Occupational Outlook Handbook page for Medical Records Specialists carries national wage and projection data and is updated annually; CareerOneStop, also from the U.S. Department of Labor, breaks wages down by state and metro area. Job postings in your own city, read over a month, tell you what employers are actually offering.
Career path
Medical records specialists are classified as a Job Zone Three occupation, 'Medium Preparation Needed' — most occupations in this zone require vocational training, related on-the-job experience or an associate's degree, and employees usually need one or two years of training (O*NET OnLine, U.S. Dept. of Labor, undated). The ladder below reflects that: short to enter, slower to climb.
| Stage | Typical titles | Usual time at this stage |
|---|---|---|
| Entry | Medical records clerk, coding assistant, billing specialist, patient account representative | 1–2 years |
| Mid | Outpatient or inpatient coder, coding specialist, denials or AR specialist, billing supervisor | 2–5 years |
| Senior | Coding auditor, clinical documentation specialist, coding manager, revenue cycle lead | 5–10+ years |
| Beyond coding | Health information technologist, medical registrar, medical or health services manager | After further study |
Entry (years 0–2). People starting a career as a medical records specialist usually have a postsecondary certificate, no work experience and no on-the-job training (CareerOneStop, U.S. Dept. of Labor, undated). You will be checked behind, which is normal. Use this stage to pick a lane — inpatient or outpatient, coding or billing.
Mid (years 2–5). You code independently to a production target, handle a specialty, and start being asked to explain payer rules to clinicians. This is where a second credential in a specialty or in auditing usually pays for itself.
Senior (years 5–10 and beyond). Auditing other coders, running education after an audit finding, or owning a piece of the revenue cycle. Management roles add hiring, scheduling and budget responsibility.
Moving out of coding. Medical records specialists may advance to become health information technologists or medical registrars, or medical or health services managers, after completing a higher certification program or earning a degree in health information technology (U.S. Bureau of Labor Statistics, 2025). If that is the destination, start the degree while you are coding rather than after — employers in this field often contribute towards it.
Frequently asked questions
Do you need a degree to become a medical biller and coder?
Not usually. The U.S. Bureau of Labor Statistics (2025) lists the typical entry-level education for medical records specialists as a postsecondary nondegree award, with no related work experience required. Survey respondents for the occupation said a high school diploma or equivalent is required for new hires in 52% of cases, a post-secondary certificate in 22%, and some college without a degree in 13% (O*NET OnLine, U.S. Dept. of Labor, undated). A high school diploma is required to sit AHIMA's CCA exam (AHIMA, undated). A degree becomes relevant later: moving into health information technologist, medical registrar or health services manager roles typically follows a higher certification program or a degree in health information technology (U.S. Bureau of Labor Statistics, 2025).
Can medical billers and coders work remotely?
Often, but rarely on day one. The work is screen-based and portable, and 10% of medical records specialists worked in professional, scientific and technical services and 8% in administrative and support services in 2025 (U.S. Bureau of Labor Statistics, 2025) — categories that include billing and outsourced coding companies, where remote work is common. In practice most employers want a year or two of production coding before they let you work unsupervised from home, and remote roles still involve strict confidentiality requirements for patients' records (U.S. Bureau of Labor Statistics, 2025), which usually means a locked, private workspace and employer-controlled equipment. Hospital roles may include nights or weekends because the facility never closes (U.S. Bureau of Labor Statistics, 2025).
How long does it take to get your first job?
Plan on six to eighteen months from your first class to your first paycheque. A certificate program covering anatomy and physiology, medical terminology and basic ICD and CPT coding typically runs four months to a year, exam prep adds two to four months on top or alongside, and applications take another one to four. The spread comes from study pace, whether you resit the exam — the 2025 first-time pass rate for AHIMA's CCA was 62% (AHIMA, 2025) — and how many entry-level openings your local hospitals and clinics have. Applying before you are certified helps, since employers may expect applicants to earn certification shortly after being hired rather than before (U.S. Bureau of Labor Statistics, 2025).
Which certification should I start with?
Start with one, chosen for the jobs you can see in your area. AHIMA's Certified Coding Associate requires a high school diploma, and AHIMA recommends but does not require at least six months of coding experience, completion of an AHIMA-approved coding program (PCAP), or other training covering anatomy and physiology, medical terminology and basic ICD and CPT coding (AHIMA, undated). It costs $199 for members and $299 for non-members, with retakes at the same price (AHIMA, undated). AAPC's Certified Professional Coder is the other common first credential; third-party guides report it at $375–$399 for one attempt or $475–$499 for a two-attempt bundle, with required membership of roughly $157–$222 a year, though those figures were not confirmed on AAPC's own site (Superprof, citing AAPC pricing, undated). Read local job postings and see which letters they ask for before you pay anything.
What's the hardest part of the first year?
Being measured. Most employers set a chart or claim volume target alongside an accuracy threshold, and new coders routinely hit one at the expense of the other. Audits are routine, and you will be asked to explain specific decisions weeks after you made them, which is why keeping a short note of why you chose a code is worth the thirty seconds. The other common shock is physician queries: asking a clinician for clarification without sounding like you are second-guessing their medicine takes practice, and the job description names you as the liaison between providers and the billing office (U.S. Bureau of Labor Statistics, 2025).
Sources
- U.S. Bureau of Labor Statistics — Medical Records Specialists : Occupational Outlook Handbook (2025)
- O*NET OnLine (U.S. Dept. of Labor) — 29-2072.00 - Medical Records Specialists
