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Claims resolution specialist vs reimbursement specialist

The differences between claims resolution specialists 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 claims resolution specialist and a reimbursement specialist. Additionally, a claims resolution specialist has an average salary of $38,432, which is higher than the $38,273 average annual salary of a reimbursement specialist.

The top three skills for a claims resolution specialist include patients, medical terminology and insurance claims. The most important skills for a reimbursement specialist are patients, customer service, and appeals.

Claims resolution specialist vs reimbursement specialist overview

Claims Resolution SpecialistReimbursement Specialist
Yearly salary$38,432$38,273
Hourly rate$18.48$18.40
Growth rate-4%11%
Number of jobs55,41332,292
Job satisfaction--
Most common degreeBachelor's Degree, 52%Bachelor's Degree, 40%
Average age4045
Years of experience1212

What does a claims resolution specialist do?

Claims resolution specialists are in charge of outstanding claims follow-ups, submitting appeals, and corresponding to work claims. To be good at this job, they find different techniques to resolve outstanding patient claims. When performing their duties, these specialists make sure that they work with professionalism and high detail quality. They should be comfortable with navigating computerized claims and various platforms while assisting their clients over the phone. These types of specialists also always maintain the confidentiality of their members' data.

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.

Claims resolution specialist vs reimbursement specialist salary

Claims resolution specialists and reimbursement specialists have different pay scales, as shown below.

Claims Resolution SpecialistReimbursement Specialist
Average salary$38,432$38,273
Salary rangeBetween $30,000 And $47,000Between $29,000 And $49,000
Highest paying City-Lynchburg, VA
Highest paying state-Virginia
Best paying company-Novartis
Best paying industry-Pharmaceutical

Differences between claims resolution specialist and reimbursement specialist education

There are a few differences between a claims resolution specialist and a reimbursement specialist in terms of educational background:

Claims Resolution SpecialistReimbursement Specialist
Most common degreeBachelor's Degree, 52%Bachelor's Degree, 40%
Most common majorBusinessBusiness
Most common college-University of Pennsylvania

Claims resolution specialist vs reimbursement specialist demographics

Here are the differences between claims resolution specialists' and reimbursement specialists' demographics:

Claims Resolution SpecialistReimbursement Specialist
Average age4045
Gender ratioMale, 26.0% Female, 74.0%Male, 15.2% Female, 84.8%
Race ratioBlack or African American, 11.4% Unknown, 5.1% Hispanic or Latino, 20.6% Asian, 6.2% White, 56.0% American Indian and Alaska Native, 0.6%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 Percentage7%9%

Differences between claims resolution specialist and reimbursement specialist duties and responsibilities

Claims resolution specialist example responsibilities.

  • Manage expedition of appeals via problem solving and collaboration with other departments.
  • Assist provider with ICD-9, CPT and revenue codes, DME, coordination of benefits, efficiently train on HIPPA.
  • Process medical claims submit to Kansas Medicaid using establish guidelines and policies.
  • Ensure compliance with HIPAA regulations and requirements.
  • Determine the types of claims using submit diagnoses, CPT, and HCPS codes.
  • Communicate with claimants and insure individuals alike while ensuring privacy and HIPPA laws are maintain.
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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.
  • Show more

Claims resolution specialist vs reimbursement specialist skills

Common claims resolution specialist skills
  • Patients, 13%
  • Medical Terminology, 7%
  • Insurance Claims, 6%
  • Patient Accounts, 5%
  • Medicaid, 5%
  • CPT, 5%
Common reimbursement specialist skills
  • Patients, 20%
  • Customer Service, 9%
  • Appeals, 6%
  • CPT, 5%
  • Medicare, 4%
  • Medicaid, 4%

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