Medical Billers and Coders: Understanding the Key Differences

Let’s be real—there’s a lot of confusion when it comes to the differences between medical billers and coders. Unless you’re deep in the medical billing and coding world, or you’ve dealt directly with the revenue cycle, you might not fully understand how these two roles function.

Providers, especially those working for large healthcare organizations, often don’t need to worry about billing and coding. They’ve got entire departments handling that stuff. But if you’re opening your own practice? Yeah, you better learn it.

And even if you’re not running your own show, understanding the differences between medical billers and coders can help you appreciate your team a little more. Plus, if you’re ever wondering why claims get rejected, why insurance denies coverage, or why payments take forever—this knowledge will make a lot more sense.

Key Takeaways:

Medical coders translate patient visits into standardized billing codes (CPT, ICD-10, modifiers).
Medical billers submit claims, track payments, and handle insurance denials.
Coders ensure claims are correct before submission, while billers ensure they get paid after submission.
Some practices combine the roles, while others outsource one or both.
A hybrid approach (in-house coding, outsourced billing) can offer the best of both worlds.

Medical Coder vs. Medical Biller: Who Does What?

Medical Coders: The Architects of Your Claims

A medical coder is responsible for translating healthcare services into billable codes. They take your chart notes, documentation, and patient visits, and extract the appropriate:

CPT codes (procedure codes)
ICD-10 codes (diagnosis codes)
Modifiers (super important for making sure claims get paid correctly)

Coders don’t just slap codes on a claim and call it a day. They have to:

Make sure everything is in the right sequence
Ensure all necessary modifiers are applied (trust me, this can make or break a claim)
Stay updated on payer-specific regulations (because insurance companies love to change the rules on a whim)

This is especially important in specialties like podiatry, where you might need to document things like a rendering provider’s NPI or a patient’s last visit date just to bill certain services. Miss a detail? Denied claim. No payment.

A good coder isn’t just preventing mistakes—they’re also making sure you get paid everything you deserve. They’ll spot opportunities to add additional codes when appropriate (like billing for an extended visit), helping you maximize revenue without overcoding and risking an audit.

Because, yeah—overcoding can flag you for an audit, and nobody wants that.

Medical Billers: The Money Collectors

If coders are responsible for structuring a claim correctly, billers are the ones making sure the money actually gets into your bank account.

Once a coder has built a claim, the biller:

Submits it to insurance
Tracks rejections and denials (if something’s wrong, it goes back to the coder for a fix)
Handles payment processing (posting payments, tracking reimbursements, etc.)
Communicates with patients (you know, the ones calling with billing questions)

Billers are the ones following up on denied claims, arguing with insurance companies (because insurers will always try to pay as little as possible), and making sure everything runs smoothly after the claim is submitted.

They also need to watch for trends—if claims keep getting denied for the same reason, they have to work with the coder to fix the root cause before it turns into a bigger problem.

Why You Need Both: Medical Billers and Coders Work Together

If you’ve ever worked with a third-party billing service, you might assume they handle everything—but most of them don’t do coding.

That means you’re either coding your own claims (which can lead to missed payments or denied claims) or hiring a separate coder to handle it. If you’re outsourcing billing, you need to clarify whether coding is included, because you don’t know what you don’t know.

Coders and billers work together to make sure claims are clean, accurate, and profitable. If claims keep getting denied, the biller works with the coder to fix the issue before resubmitting. A strong coder prevents mistakes before they happen, while a skilled biller fights to get every dollar you’re owed.

Choosing the Right Billing and Coding Setup for Your Practice

Now that you know the differences between medical billers and coders, let’s talk about how to set up your billing and coding process the right way. Whether you’re running a small private practice or a growing clinic, getting paid on time and avoiding claim denials is critical.

But here’s the thing—there’s no one-size-fits-all solution. The right setup depends on your specialty, patient volume, and budget. Let’s break it all down.

In-House vs. Outsourced Billing and Coding: Which One is Best?

One of the biggest decisions you’ll face is whether to handle billing and coding in-house or outsource it. There are pros and cons to both, and choosing the wrong option can cost you a lot of money.

Option 1: In-House Billing and Coding

If you want total control over your revenue cycle, handling medical billing and coding in-house might be the way to go.

Pros of In-House Billing & Coding:

More control over claims (fewer errors, faster corrections)
Specialty-specific expertise (your team understands the nuances of your practice)
Easier communication (coders and billers can work directly with providers)
Better compliance tracking (staying on top of ever-changing regulations)

Cons of In-House Billing & Coding:

Higher costs (you’ll need to hire and train staff, plus pay salaries and benefits)
Software expenses (billing and coding software isn’t cheap)
Ongoing training required (coding guidelines change constantly)

Best for: Medium-to-large practices that can afford dedicated staff and want full control over billing and coding.

Option 2: Outsourced Medical Billing and Coding

Many practices outsource billing to third-party companies, but here’s where it gets tricky—most of them don’t do coding. That means you’re either:

Handling coding yourself (which can lead to costly mistakes), or
Hiring a separate coder (which adds another layer of expense and complexity).

Pros of Outsourcing:

Lower upfront costs (no need to hire full-time staff)
Less administrative work (you don’t have to worry about claims processing)
Billing expertise (third-party billers specialize in getting claims paid)

Cons of Outsourcing:

Less control over claims (if a billing company isn’t aggressive with denials, you lose money)
Potential for errors (they might not understand your specialty’s coding requirements)
Hidden fees (some companies charge a percentage of revenue, which adds up fast)

Best for: Small practices or providers who don’t have the staff or budget to manage billing in-house.

In-House Staff vs. Outsourced Billing Services: Which is Better for Your Practice?

How to Choose the Right Medical Billing Company

If you decide to outsource your billing, be very careful who you hire. Some billing companies only submit claims, while others offer full revenue cycle management (including handling denials and patient collections).

Here are the key questions to ask any billing company before signing a contract:

Do you handle coding, or just billing? (If they don’t do coding, you’ll need a separate solution.)
How do you handle denied claims? (Do they resubmit automatically, or do you have to fix them?)
What percentage of revenue do you take? (Some charge a flat fee, others take a percentage.)
Do you work with my specialty? (A billing company that specializes in dermatology might struggle with podiatry or cardiology billing.)
What software do you use, and will I have access? (You need visibility into your claims and payments.)

The Hybrid Approach: The Best of Both Worlds?

Some practices find that a hybrid approach—keeping coding in-house while outsourcing billing—works best.

Why? Because coding is too important to outsource to just anyone. A good coder ensures your claims are correct from the start, while an experienced biller handles the insurance follow-up and patient billing.

When a Hybrid Approach Works Best

You want control over coding but don’t want to deal with billing headaches.
You see a high volume of patients and need to minimize denials.
You need specialty-specific coding expertise to ensure maximum reimbursement.

FAQ: Differences Between Medical Billers and Coders

If you’re still wondering about the differences between medical billers and coders, you’re not alone. Here are some of the most common questions people have about these two crucial roles in the healthcare revenue cycle.

What’s the biggest difference between a medical biller and a medical coder?

A medical coder translates medical services into standardized billing codes (CPT, ICD-10, and modifiers) to ensure claims are accurate and compliant before submission. A medical biller takes those coded claims, submits them to insurance companies, and handles denials, patient billing, and payment processing.

In simple terms:

Coders → Make sure the claim is correct before submission.
Billers → Make sure the claim gets paid after submission.

Do medical billers need to know coding?

Yes, but not at the same level as a coder. Billers need to understand coding basics to spot errors and process claims correctly, but they typically don’t assign codes themselves. If a claim is rejected due to a coding issue, it usually goes back to the coder for correction.

Does every medical practice need both a biller and a coder?

Not necessarily. Some small practices combine billing and coding roles into one position, while others outsource one or both. The best setup depends on practice size, specialty, and complexity of claims.

For example:

A large surgical practice → Likely needs dedicated coders and billers due to complex coding requirements.
A small family medicine clinic → May be able to handle both in-house or outsource billing while keeping coding internal.

Who earns more: a medical biller or a medical coder?

Typically, medical coders earn more than billers because their role requires specialized training and certifications. Coders often need certifications like CPC (Certified Professional Coder), while billers don’t always require formal credentials.

Role	Average Salary (USA)
Medical Coder	$50,000 – $65,000/year
Medical Biller	$40,000 – $55,000/year

Salaries depend on experience, location, and certifications.

Can a medical coder do medical billing?

Yes, but it depends on their experience and training. Many coders understand billing concepts, but billing involves insurance follow-ups, payment posting, and patient collections, which coders may not specialize in.

If you’re a small practice, you might hire a dual-role biller/coder. But in larger practices, separating the roles improves efficiency and accuracy.

Is it better to hire an in-house medical coder and biller or outsource?

It depends!

In-house: More control, faster claim corrections, and better specialty-specific expertise.
Outsourced: Less administrative work, lower payroll costs, but can lead to errors or lack of specialty knowledge.

Hybrid Approach = Best of both worlds → Keep coding in-house, outsource billing.

Why do insurance claims get denied, and who fixes them?

Claims can be denied for a ton of reasons, including:

Coding errors (incorrect CPT/ICD-10 codes, missing modifiers)
Medical necessity issues (insurance doesn’t think the service was needed)
Authorization problems (pre-approval required but not obtained)

Who fixes the denial?

If it’s a coding issue → Goes back to the coder.
If it’s a billing issue (e.g., missing documentation) → The biller handles it.

Do third-party billing companies handle coding too?

Most don’t. They usually only process claims based on the codes given to them. That’s why it’s critical to ask if coding is included when outsourcing billing.

If they don’t do coding, you’ll need an in-house coder or a separate coding service to make sure claims are accurate before submission.

How can I reduce claim denials and increase reimbursement?

Hire an experienced coder (to prevent coding errors before submission).
Train your front desk staff (so they collect accurate patient and insurance info upfront).
Work with a biller who actively fights denials (instead of just resubmitting and hoping for the best).
Stay updated on payer requirements (because insurance rules change constantly).

Do medical coders and billers need to be certified?

Medical Coders: Usually, yes! Most employers require certification like:
- CPC (Certified Professional Coder)
- CCA (Certified Coding Associate)
- CCS (Certified Coding Specialist)
Medical Billers: Certification is not always required, but it helps! Some get:
- CPB (Certified Professional Biller)
- CMRS (Certified Medical Reimbursement Specialist)

Final Thoughts: Invest in Your Revenue Cycle

No matter which setup you choose, one thing is clear—billing and coding are the backbone of your revenue cycle. Whether you hire in-house, outsource, or do a mix of both, the goal is the same:

✔ Minimize errors
✔ Reduce denials
✔ Get paid everything you’re owed

A strong coder makes sure claims are correct before submission, while a skilled biller ensures claims get paid after they’re sent. Together, they keep your revenue flowing.

And let’s be honest—you deserve to get paid for every service you provide. So don’t cut corners on billing and coding.