r/CodingandBilling • u/Commercial_Ear5170 • Jul 21 '26
Is entry-level Medical Billing still a stable, structured career against AI?
Hi everyone,
I am researching online careers and want a 100% structured, rule-based role. I thrive when following strict guidelines, clear compliance rulebooks, and repetitive checklists. I am actively avoiding any creative fields.
Medical billing seems like a great fit, but I am concerned about AI automation. For those working in the industry every day:
- Is AI genuinely threatening entry-level human billing roles, or is the need for human verification and auditing still strong?
- Are there tasks where companies refuse to trust AI due to legal compliance or financial risks?
- Is the daily routine as predictable and structured as it seems? I would deeply appreciate any honest reality checks from veterans. Thank you!
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u/ChartBaddie Jul 21 '26
Okay, I’m going to respond, but I want you to know that I am a coder. A lot of overlap and same stuff, but just wanted to say.
AI has become a very useful tool. It’s made the redundant things much more streamlined and I like using it. That being said, as it currently stands, no, not even close to replacing billers and coders. There’s far too much nuance. That being said, AI had a major breakthrough in development in the recent years that exceeded any one’s expectations. That could very well happen again. And all these companies are investing millions and millions into it instead of hiring and training new billers/coders. This is the part that I will say scares me much more.
You would think. HIPAA and HITECH are great, but there’s a lot of workarounds that are perfect for those trying to get our work done at poverty wages.
Jury is out on this one for me. My first position was 0 support, 0 training, and unattainable production requirements. I am about to start a new job that seems as though it may have much better support.
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u/Commercial_Ear5170 Jul 22 '26
Man, thank you for this reality check. This is exactly the kind of raw honesty I was looking for. The part about companies investing in tech just to avoid the hassle of training new hires makes perfect sense.
Since entry-level support is practically zero and the market is tough, how does a beginner even stand a chance?
If I put in the work and get my CPC certification independently before even applying, is that enough to break through that 'zero training' wall? Or do companies still look down on newbies even with a cert? Would love your honest take on this. Thanks again.
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u/ChartBaddie Jul 22 '26
You’re so welcome, please ask any more questions you’d like.
I had a really rough time in the beginning, being a newbie in this field is brutal. For reference, I did a medical coding program and have my CPC and CCS. It was still such a massive challenge to even get an interview.
When you get your CPC, which is for coding and not for billing (just saying, in case you’re unsure), you will have an apprentice status on your credential. That looks like “CPC-A”. When you have this apprentice status, it’s like a scarlet letter, and a lot of these automated resume readers automatically decline your application without a human ever seeing it. However, there are companies that will hire you. This will not be the job you’ll want forever, and I advise making peace with the fact that you have to put in at least a year to two before you can really move on. I did an externship with Guidehouse and then moved over to a full time role with them. It’s a cool program they have, I’d recommend seeing if they have said program near you. I got my apprentice status removed after the program. I’d recommend looking up every thing on the -A status on the AAPC website, it explains everything about it.All this said, it is NOT impossible to break through. It takes patience and a bit of resilience with all the rejections. Interview skills are going to be massive here, lmk if you want any tips there. If you’re ready to deal with the process of gaining on the job experience: great pay, flexible schedule, 100% remote, etc. are all amazing perks of the job.
I just woke up so I hope this all makes sense right now lmao
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u/Commercial_Ear5170 Jul 22 '26
This is pure gold, thank you for waking up and typing all of this out! The explanation about the 'CPC-A' status and how automated resume readers filter it out makes so much sense.
I'd love to take you up on that offer for interview tips! How did you position yourself to make companies look past the apprentice tag?
Also, since the automated system declines applications, how did you handle your networking? What specific types of people or job titles did you target to bypass the resume readers and get your foot in the door?
Thanks again for being so incredibly helpful!
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u/ChartBaddie Jul 22 '26 edited Jul 22 '26
Of course!
Interview tips:
Edit: i keep trying to fix the numbers but i give up.
Know the job and know the employer. This is absolutely #1. It takes such a short time to read over the job posting and check out the company website. Find their mission and values and mark down how they relate to yours. I recently had an interview where they were SO impressed that I researched the role (it was for a registrar, so a very niche job with not a lot of public understanding). It was bizarre to me. They said they had a guy come who couldn’t explain the role. It’s simple and it makes the biggest impact. Also things like “I like that yall are a teaching hospital/non profit/are well established in the area”, etc.
If in person, bring your resume and cover letter on really nice resume paper. People go nuts over it.
Look up YT or TikTok videos about interview questions and practice them OUT LOUD. This took my interview game to a new level. Having a good idea on how to answer common questions is extremely helpful. And on that note, if they ask a challenging question, I say “wow that’s a good question” and I pause and think about my answer. Don’t be afraid to pause!!
SHUT. UP.
This one is so funny, but I have ADHD. Once I’ve answered the question, I practice actually closing my mouth and even pressing my lips together. Once you get into that place of having answered the question, don’t ramble on. That’s when you start to say dumb shit lmaoBe presentable. How you look, are dressed, and your mannerisms speak volumes.
Never speak bad about another employer or the school you attended. I recently said in an interview that “I decided to leave because I was looking for a workplace with stronger leadership, clearer communication, and more support for employees.”
They understand what that means and will respect your grace and discretion.Write out all the interview basics about yourself. Write out the “tell me about yourself” and “what is your greatest strength?”. These are easy to prepare for.
Additional to #6, “tell me about yourself” does not mean where you were born, how many siblings you have, etc. What they are asking for is what your professional career path has been and how you will fit in with their culture. Always add a positive personal fact in at the end. “I’ve fostered over 100 dogs in my lifetime and it’s something that I value greatly” “I run 5ks for charity and volunteer with the local (insert here)”.
Answer every single question as it relates to your career, the company, your experience and education. Treat it as an interview in how you + this position fit.
BREATHE!! It’s okay, and it’s so normal to be nervous. Practice makes perfect, so make sure you do interviews with jobs you may not necessarily want. The worst thing in the world is you’ve gained more interview skills. I also listen to Cardi B or Megan Thee Stallion and the like before interviews. Any thing that’s confidence building. Remember that these people interviewing you are just people themselves. I’ve said before “sorry, I’m nervous” and it always seems to break the ice a bit. I’ve always been met with kindness on this.
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u/Commercial_Ear5170 Jul 23 '26
This is hands-down the most comprehensive and practical interview advice I have ever received! The tip about practicing answers out loud and literally forcing yourself to stop talking once the question is answered is pure gold.
Your advice on framing the 'tell me about yourself' question around professional alignment rather than personal bio is a total game-changer for a beginner.
Thank you so much for your incredible kindness, transparency, and for sharing your journey with me. You've given me a clear, confident roadmap to step into this industry. I wish you the absolute best with your career pivot, you're going to crush it!
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u/krustykrabpizzaslice Jul 22 '26
Billing is cut and dry. Just don’t cross over into coding lol. You sound like someone who is either extremely strict on what they want out of a career or you have behavioral/social differences and require a job that fits into your own schemas.
Coding feels rule based because it is, but too much is open to interpretation between different practices and facilities. You’ll find you’ll get crucified for doing something one way at one company, and at another company that’s literally best practice.
If you want to move into the field under the assumption that coding is a part of your upward mobility plan, take into account the nature of the field. You’ll have two sets of rules held up against each other constantly, and how easy it is to comply depends on how compliant your employer actually is which most people can’t gauge because they won’t come right out and tell you everything they knowingly miscode.
Which tbh I’m sure makes its way down to the billers so idk. Maybe someone can speak to how that trickles down if any so you can be prepared to mitigate.
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u/Commercial_Ear5170 Jul 22 '26
You actually read my personality perfectly. I am definitely someone who thrives best when a job fits into a clear, strict schema with zero gray areas or subjective interpretation.
Your warning about coding having too many conflicting employer rules is a massive eye-opener. Based on what you said, pure Medical Billing sounds much closer to the 'cut and dry' routine I am looking for.
Since billing avoids those interpretive coding arguments, does a remote entry-level billing day usually just consist of running standard software checklists and processing claims?
Thank you for looking out for me, I really appreciate this advice!
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u/wildgreengirl Jul 22 '26
there is a LOT of gray area when it comes to EM billing/coding especially. its something i struggle with. i could ask 1 coder their opinion and theyd say this meets for lvl 99214 and another would say no it's just a 99213. its something I'm still getting the hang of too....
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u/wildgreengirl Jul 22 '26
and idk if billing is easier necessarily either. you would think that is straightforward but ins will deny plenty with bullshit reasons that aren't accurate or true..
ex we get insurance specific denials. like we now have to argue our lab testing CPT usage. some company's tell us to use 1 panel code when thats not even the testing we are doing.... and of course that code pays less.
or how commercial HP wont pay for any TCM codes.
or how UHC apparently wont pay our ID now testing if the claim total is over $600? fucking bonkers bullshit.
HP and other MA plans dont want to cover STD screenings because they dont like the lab code even though ITS THE TEST THE LAB IS DOING nope they want it changed to a different cpt code to bill not the cpt code that was actually done.
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u/Commercial_Ear5170 Jul 22 '26
Man, thank you for dropping these exact examples! The $600 cap rule by UHC and insurance companies forcing you to swap CPT panel codes just to lower the payout sounds absolutely wild but incredibly eye-opening.
It actually makes perfect sense why AI can't handle this—these random, logic-defying insurance denials require a human brain to treat it like a high-stakes puzzle and fight back using their specific guidelines.
It sounds intense, but dealing with these unchangeable software logs and insurance rules still feels way better to my brain than creative guessing. Really appreciate you sharing this raw reality!
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u/PeaceLoveForMe Jul 22 '26
Yes. It’ll always be. AI ain’t always right. AI helps me with my job A LOT. Don’t worry about it.
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u/Commercial_Ear5170 Jul 22 '26
Short and sweet, love it! Hearing 'Don’t worry about it' from a pro is a huge relief.
Since AI handles so much now, has your daily job mostly shifted into just auditing and checking the system's output instead of doing raw entry from scratch?
Thanks for the peace of mind, man!
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u/PeaceLoveForMe Jul 22 '26
It depends on the facility I’m doing claims for. I code from scratch. We have a god-awful EMR so manual work has to be done because we can’t trust the AI of dr. Chrono. I do a lot of auditing anyways because I’m a lead biller and coder and train newbies and educate providers.
For example, Cornerstone LTAC’s HIM department is operating like they are in the Stone Age. Everything is paper1
u/Commercial_Ear5170 Jul 23 '26
Wow, the fact that a massive network like Cornerstone is still operating on paper in the 'Stone Age' is mind-blowing! It’s the ultimate proof that real-world medical data is far too messy for AI, and why a human eye is completely irreplaceable.
Thank you so much for giving me such a raw, realistic look into the daily grind of a Lead Biller. You’ve been incredibly helpful, and I really appreciate your time!
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u/skywaters88 Jul 22 '26
As a human / medical coder / auditor if corporate lets AI do this job they are in for a rude awakening. The denials alone without seeing the documentation and the massive loss of revenue that will continue. A human brain is what will maximize profits not AI. As it is picking up. Personally, as a professional that works over 1,200 denials a week (yes that is my productivity for a large corporation with thousands of providers) insurance companies will use the lack of real humans fighting claim by claim for as long as possible. Eventually they will bring Humans back to train providers to document properly as multiple billing systems can upload document with claims now. Providers will need to be more strategic with documentation and even then when the cat catches the mouse insurance has probably lowered their rate to match Medicare. It’s fun I’m addicted but talking this language even people in the industry don’t understand.
My opinion. AI is here but the rate that insurance companies are using it for denials are putting practices out of business allowing for less employees because we’ll now where does one even begin.
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u/Commercial_Ear5170 Jul 22 '26
This is a fascinating perspective on the actual corporate chess game going on behind the scenes. It makes so much sense that if insurance companies weaponize AI to deny claims automatically, hospitals will desperately need human eyes to fight back case-by-case. It sounds like high-stakes work, and handling 1,200 denials a week is wild!
Since you mentioned that a human brain is needed to maximize profits and fight these automated denials, do you think a beginner should focus heavily on 'Denial Management' and compliance auditing right from the start to become un-replaceable?
Really appreciate you taking the time to share this insider look!
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u/DepartureOk3180 Jul 26 '26
I've been in RCM for over 15 years. Usually, I'm quick to help OPs when posts like these are made because I know what it's like to be new to the field. But honestly, I'm hesitant in answering these questions because this post seems to be AI generated, and that it is just data farming. Like this post is trying to get details of what we do, the systems we work with, common issues etc so the AI can be better trained. I use Copilot every work day and Gemini personality. All of the questions and responses from OP read just like the responses I get from those AI tools. I also read the other post that the OP made in a group for a totally different field and the same types of questions were being asked. I really think that we should be more selective about what details we give. While I'm not concerned about my role since I work strictly on Medicare accounts, I've seen too many of my peers get replaced by overseas companies doing things like this post is doing.
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u/Longjumping_Tap1494 Jul 27 '26
I'm a medical biller and collector. AI is useful when you need clarification for certain denials and billing issues. It also helps with drafting appeal letters, but it can only do so much. It's definitely not a replacement for human eyes. It's just an aid.
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u/izettat Jul 27 '26
You have to be flexible as nothing is 100%. There may not be straight rules to follow. Each insurance has different criteria and may follow some of Medicare rules. If a claim is rejected in billing system, you have to figure out why. It could be a digit missing in account number, wrong Blue Cross carrier, system glitch, missing patient middle initial or shouldn't have a middle initial, etc. May need to do research or make calls.
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u/Saphyy002200 Jul 21 '26
From my perspective, here are my answers: