A Day in the Life of a Medical Biller and Coder

Your day typically starts between 7:30 and 9:00 a.m., depending on your employer and whether you're working on-site or from home. The first task is pulling up your coding queue, which is the list of patient charts waiting for code assignment. In most offices, charts flow into this queue automatically after providers complete their clinical documentation.

For each chart, you'll read the physician's notes, lab results, imaging reports, and any procedure documentation. Then you'll assign the correct ICD-10-CM diagnosis codes and CPT procedure codes based on what's documented. This step requires careful attention because the codes you select directly determine how much the practice gets paid. Undercoding leaves money on the table. Overcoding triggers audits and potential fraud allegations.

In an outpatient primary care office, you might process 60 to 80 charts in a morning because most visits involve straightforward E/M (Evaluation and Management) codes. In a surgical or specialty practice, you'll handle fewer charts because the documentation is more complex and often involves multiple procedure codes, modifiers, and bundling rules.

Once codes are assigned, the billing side kicks in. If your office separates billing and coding roles, a biller picks up where you left off. If you handle both (common in smaller practices), you'll submit coded claims to insurance payers through a clearinghouse or directly through payer portals.

Before submission, claims go through a "scrubbing" process where software checks for common errors: mismatched diagnosis and procedure codes, missing modifiers, invalid patient demographics, and authorization gaps. You'll fix any flagged issues before sending the claim out. Clean claim rates matter because every rejected claim means rework and delayed payment.

You'll also spend time checking the status of previously submitted claims. Insurance companies don't always process claims quickly, and following up on pending claims is a routine part of the billing workflow. This involves logging into payer portals (UnitedHealthcare, Aetna, Blue Cross, Medicare) and tracking where each claim sits in the adjudication process.

The afternoon often involves denial management. When insurance companies reject or underpay claims, someone has to figure out why and fix it. Common denial reasons include incorrect patient information, coding errors, lack of prior authorization, and medical necessity disputes.

For simple denials (a typo in the patient ID, a missing modifier), you'll correct the claim and resubmit. For complex denials, you might need to write an appeal letter with supporting documentation from the provider. This is where strong knowledge of payer rules, coding guidelines, and clinical terminology all come together.

The last part of your day typically includes wrapping up any remaining charts in your queue, responding to queries from providers who need clarification on documentation requirements, and updating internal tracking spreadsheets or dashboards. Many offices hold brief end-of-day huddles to discuss coding questions, policy updates, or problematic claims.

Electronic Health Records (EHR). You'll spend most of your screen time in an EHR system. Epic and Cerner are the most common in hospitals and large health systems. Smaller practices often use AdvancedMD, athenahealth, Kareo, or DrChrono. The EHR is where you access patient charts, clinical notes, and documentation.

Encoder software. Tools like 3M CodeFinder, Optum EncoderPro, or TruCode help you look up codes, check bundling rules, verify medical necessity, and apply the correct modifiers. Most employers provide encoder access, and learning to use it efficiently is one of the fastest ways to increase your productivity.

Practice management and billing software. This is where claims get built, scrubbed, submitted, and tracked. Systems like Waystar, Availity, and Office Ally handle clearinghouse functions. You'll also log into individual payer portals (Medicare's MAC portals, commercial insurance sites) to check claim status and eligibility.

Constant guideline changes. ICD-10-CM, CPT, and HCPCS codes update every year. Payer-specific rules change even more often. You'll need to stay current with annual code updates (typically effective October 1 for ICD-10-CM and January 1 for CPT) and any mid-year revisions. This is why both AAPC and AHIMA require continuing education for certification maintenance.

Repetitive screen work. Coding is almost entirely computer-based. If you don't enjoy working at a screen for 7 to 8 hours, this role will feel draining. Experienced coders manage this by taking regular breaks, using ergonomic setups, and varying their tasks throughout the day.

Accuracy pressure. Coding errors can trigger claim denials (lost revenue), compliance audits, or even fraud investigations in extreme cases. Accuracy rates of 95% or higher are the standard expectation. Most employers track your accuracy and productivity metrics weekly or monthly.

Provider pushback. Occasionally, a provider's documentation doesn't support the code they want billed. You'll need to query the provider for clarification, which sometimes creates friction. Handling these conversations diplomatically, while protecting coding compliance, is a skill that develops with experience.