Certified professional coder vs reimbursement specialist

The differences between certified professional coders and reimbursement specialists can be seen in a few details. Each job has different responsibilities and duties. It typically takes 6-12 months to become both a certified professional coder and a reimbursement specialist. Additionally, a certified professional coder has an average salary of $52,683, which is higher than the $38,273 average annual salary of a reimbursement specialist.

The top three skills for a certified professional coder include CPC, medical terminology and AAPC. The most important skills for a reimbursement specialist are patients, customer service, and appeals.

Certified professional coder vs reimbursement specialist overview

	Certified Professional Coder	Reimbursement Specialist
Yearly salary	$52,683	$38,273
Hourly rate	$25.33	$18.40
Growth rate	11%	11%
Number of jobs	86,465	32,292
Job satisfaction	-	-
Most common degree	Associate Degree, 34%	Bachelor's Degree, 40%
Average age	45	45
Years of experience	12	12

What does a certified professional coder do?

A certified professional coder oversees the daily medical coding operations of a medical facility, ensuring compliance with industry standards and regulations. They usually have the responsibility to provide coding to facilities, update databases, and conduct reviews and assessments to identify missing details or inconsistencies and perform corrective measures. Moreover, as a certified professional coder, it is essential to coordinate with external parties such as insurance providers and communicate with patients, assisting them by answering inquiries, explaining procedures, and solving issues and concerns if any would arise.

What does a reimbursement specialist do?

A reimbursement specialist is responsible for analyzing insurance documents, processing reimbursement claims, and releasing accurate billing statements for insurance claims. Reimbursement specialists must have excellent analytical skills, especially on performing clerical tasks to evaluate insurance cases, investigate cases, and update the account information of the clients on the database. They should also have impeccable communication skills and understanding of the insurance processes to be able to coordinate with the clients, explaining the procedures of their claims accurately, and coordinate with the insurance management to improve the claims processes.

Certified professional coder vs reimbursement specialist salary

Certified professional coders and reimbursement specialists have different pay scales, as shown below.

	Certified Professional Coder	Reimbursement Specialist
Average salary	$52,683	$38,273
Salary range	Between $38,000 And $73,000	Between $29,000 And $49,000
Highest paying City	Baltimore, MD	Lynchburg, VA
Highest paying state	Alaska	Virginia
Best paying company	Morgan Stanley	Novartis
Best paying industry	Technology	Pharmaceutical

Differences between certified professional coder and reimbursement specialist education

There are a few differences between a certified professional coder and a reimbursement specialist in terms of educational background:

	Certified Professional Coder	Reimbursement Specialist
Most common degree	Associate Degree, 34%	Bachelor's Degree, 40%
Most common major	Health Care Administration	Business
Most common college	Stanford University	University of Pennsylvania

Certified professional coder vs reimbursement specialist demographics

Here are the differences between certified professional coders' and reimbursement specialists' demographics:

	Certified Professional Coder	Reimbursement Specialist
Average age	45	45
Gender ratio	Male, 8.9% Female, 91.1%	Male, 15.2% Female, 84.8%
Race ratio	Black or African American, 8.8% Unknown, 4.5% Hispanic or Latino, 14.8% Asian, 8.3% White, 62.0% American Indian and Alaska Native, 1.6%	Black or African American, 9.8% Unknown, 4.2% Hispanic or Latino, 16.9% Asian, 8.1% White, 59.8% American Indian and Alaska Native, 1.3%
LGBT Percentage	9%	9%

Differences between certified professional coder and reimbursement specialist duties and responsibilities

Certified professional coder example responsibilities.

Manage the outsourced transcription company.
Apply ICD-10-CM, CPT-4 codes and modifiers in accordance with federal regulations.
Validate DRG's for inpatient and inpatient RAC appeals as well as validating DRG changes.
Assist with insurance verification and registration, including Medicare and Medicaid.
Review, analyze, and code all ICD-9-CM and ICD-10-CM diagnoses.
Work all age reports for all Medicaid.

Reimbursement specialist example responsibilities.

Manage the EDI clearinghouse rejections.
Process department payroll, order supplies, and manage petty-cash funds.
Manage use of various systems, such as MEDITECH, Cerner, WebNow, and yield-base follow-up tool.
Manage cases by aggressively directing the litigation process.
Negotiate fee structure for manage care contracts on acute and rehabilitation facilities.
Research medical coding ICD-9, ICD-10, HCPCS and CPT-4 to let client know the outcome of medical claim.

Certified professional coder vs reimbursement specialist skills

Common certified professional coder skills

CPC, 20%
Medical Terminology, 9%
AAPC, 8%
Patients, 7%
ICD-10-CM, 5%
E/M, 4%

Common reimbursement specialist skills

Patients, 20%
Customer Service, 9%
Appeals, 6%
CPT, 5%
Medicare, 4%
Medicaid, 4%

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Certified Professional Coder vs Reimbursement Specialist

Updated January 8, 2025

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