Medical billing clerk vs medical claims processor

The differences between medical billing clerks and medical claims processors can be seen in a few details. Each job has different responsibilities and duties. While it typically takes 1-2 years to become a medical billing clerk, becoming a medical claims processor takes usually requires 2-4 years. Additionally, a medical claims processor has an average salary of $36,777, which is higher than the $33,566 average annual salary of a medical billing clerk.

The top three skills for a medical billing clerk include patients, medical billing and healthcare. The most important skills for a medical claims processor are patients, healthcare, and data entry.

Medical billing clerk vs medical claims processor overview

	Medical Billing Clerk	Medical Claims Processor
Yearly salary	$33,566	$36,777
Hourly rate	$16.14	$17.68
Growth rate	-3%	-3%
Number of jobs	164,870	59,992
Job satisfaction	-	-
Most common degree	Associate Degree, 30%	Bachelor's Degree, 29%
Average age	46	44
Years of experience	2	4

What does a medical billing clerk do?

A medical billing clerk is primarily in charge of processing payments and creating billing arrangements in clinics and hospitals. Among their responsibilities include gathering and verifying patient identification, handling insurance information, coding, updating databases, and maintaining records. It is also their responsibility to assist patients by filling out forms, answering their inquiries, and referring them to other services. Moreover, a medical billing clerk must monitor patient accounts and follow-up on delinquent patient accounts, coordinating with collection agencies as needed.

What does a medical claims processor do?

A medical claims processor has working knowledge of medical billing and coding. The qualifications for this position include knowledge of current procedural terminology (CPT) and international classification of diseases (ICD) coding systems. They are responsible for processing claims forms, adjudicating the allocation of deductibles and copays, and following through with adjudication policies to facilitate proper payment of claims.

Medical billing clerk vs medical claims processor salary

Medical billing clerks and medical claims processors have different pay scales, as shown below.

	Medical Billing Clerk	Medical Claims Processor
Average salary	$33,566	$36,777
Salary range	Between $27,000 And $40,000	Between $29,000 And $45,000
Highest paying City	San Leandro, CA	Dover, DE
Highest paying state	Washington	Delaware
Best paying company	iCare	Cognizant
Best paying industry	Health Care	Government

Differences between medical billing clerk and medical claims processor education

There are a few differences between a medical billing clerk and a medical claims processor in terms of educational background:

	Medical Billing Clerk	Medical Claims Processor
Most common degree	Associate Degree, 30%	Bachelor's Degree, 29%
Most common major	Health Care Administration	Business
Most common college	Stanford University	-

Medical billing clerk vs medical claims processor demographics

Here are the differences between medical billing clerks' and medical claims processors' demographics:

	Medical Billing Clerk	Medical Claims Processor
Average age	46	44
Gender ratio	Male, 11.3% Female, 88.7%	Male, 16.0% Female, 84.0%
Race ratio	Black or African American, 10.4% Unknown, 4.3% Hispanic or Latino, 21.9% Asian, 6.8% White, 55.8% American Indian and Alaska Native, 0.8%	Black or African American, 13.8% Unknown, 4.3% Hispanic or Latino, 14.4% Asian, 3.9% White, 63.2% American Indian and Alaska Native, 0.5%
LGBT Percentage	7%	11%

Differences between medical billing clerk and medical claims processor duties and responsibilities

Medical billing clerk example responsibilities.

Accept and process healthcare claims and confidential medical records; verify patient eligibility and manage the Medicare and Medicaid billing process.
Interact with patients as part of the quality assurance process (follow-up, EHR confirmation, billing confirmation).
Reconcile insurance and patient payments while researching and resolving incorrect payments, EOB rejections, and assort issues with outstanding accounts.
Utilize medical terminology and follow HIPAA guidelines.
Bill Magellan through Nextgen system.
Double checked CMS-1500 form before posting it out to the insurance companies.

Medical claims processor example responsibilities.

Enter UB 92 and 1500 HCFA medical claims into computer system manage and process insurance claims.
Manage cases by aggressively directing the litigation process.
Submit medical claims to commercial insurance companies, Medicare, and Medicaid for payment with use of ICD-9 and CPT coding.
Review and verify patient account information against insurance program specifications, analyze surgical procedures and diagnoses using CPT-4 and ICD-9 codes.
Acknowledge and enforces confidentiality in alignment with (HIPPA) guidelines.
Audit encounters and ICD-10 codes to ensure correct coding and maximum reimbursement.

Medical billing clerk vs medical claims processor skills

Common medical billing clerk skills

Patients, 18%
Medical Billing, 10%
Healthcare, 7%
Data Entry, 7%
Customer Service, 6%
Medicaid, 5%

Common medical claims processor skills

Patients, 13%
Healthcare, 10%
Data Entry, 10%
Medical Insurance Claims, 9%
Medical Terminology, 6%
Customer Service, 3%

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Medical Billing Clerk
Medical Billing Clerk vs Medical Claims Processor

Updated January 8, 2025

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