Medicaid specialist vs reimbursement specialist

The differences between medicaid specialists and reimbursement specialists can be seen in a few details. Each job has different responsibilities and duties. While it typically takes 1-2 years to become a medicaid specialist, becoming a reimbursement specialist takes usually requires 6-12 months. Additionally, a medicaid specialist has an average salary of $44,308, which is higher than the $38,273 average annual salary of a reimbursement specialist.

The top three skills for a medicaid specialist include patients, home health and medicaid eligibility. The most important skills for a reimbursement specialist are patients, customer service, and appeals.

Medicaid specialist vs reimbursement specialist overview

	Medicaid Specialist	Reimbursement Specialist
Yearly salary	$44,308	$38,273
Hourly rate	$21.30	$18.40
Growth rate	-	11%
Number of jobs	73,368	32,292
Job satisfaction	-	-
Most common degree	Bachelor's Degree, 53%	Bachelor's Degree, 40%
Average age	46	45
Years of experience	2	12

What does a medicaid specialist do?

A Medicaid Specialist is a social service worker who focuses on assisting individuals when it comes to Medicaid programs. They are responsible for helping individuals understand the health care system procedures and requirements, answering inquiries, or referring them to other services. There are also Medicaid specialists who mostly perform clerical support tasks such as gathering and verifying documents, conducting research and analyses, handling calls and correspondence, reaching out to medical facilities and insurance companies, and maintaining records.

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.

Medicaid specialist vs reimbursement specialist salary

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

	Medicaid Specialist	Reimbursement Specialist
Average salary	$44,308	$38,273
Salary range	Between $29,000 And $67,000	Between $29,000 And $49,000
Highest paying City	-	Lynchburg, VA
Highest paying state	-	Virginia
Best paying company	-	Novartis
Best paying industry	-	Pharmaceutical

Differences between medicaid specialist and reimbursement specialist education

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

	Medicaid Specialist	Reimbursement Specialist
Most common degree	Bachelor's Degree, 53%	Bachelor's Degree, 40%
Most common major	Business	Business
Most common college	University of Michigan - Ann Arbor	University of Pennsylvania

Medicaid specialist vs reimbursement specialist demographics

Here are the differences between medicaid specialists' and reimbursement specialists' demographics:

	Medicaid Specialist	Reimbursement Specialist
Average age	46	45
Gender ratio	Male, 16.7% Female, 83.3%	Male, 15.2% Female, 84.8%
Race ratio	Black or African American, 21.6% Unknown, 4.2% Hispanic or Latino, 14.7% Asian, 7.8% White, 50.5% American Indian and Alaska Native, 1.2%	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	7%	9%

Differences between medicaid specialist and reimbursement specialist duties and responsibilities

Medicaid specialist example responsibilities.

Generate reports for managing compliance with Medicaid documentation in support of electronic billing to MCO
Acquire valuable expertise of HIPAA, Medicaid and patient confidentiality.
Provide excellent compassionate customer service to all patients, honoring patient privacy according to HIPAA regulations.
Review referrals and screen all uninsure patients seen at contract HCA hospitals for potential Medicaid and/or disability eligibility.
Adhere to all HIPPA laws.
Ensure ICD-9-CM, CPT, and HCPCS codes are correct for billing.

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.

Medicaid specialist vs reimbursement specialist skills

Common medicaid specialist skills

Patients, 23%
Home Health, 13%
Medicaid Eligibility, 13%
Rehabilitation, 9%
Social Work, 5%
Term Care, 4%

Common reimbursement specialist skills

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

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Medicaid Specialist
Medicaid Specialist vs Reimbursement Specialist

Updated January 8, 2025

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