Medical claims analyst vs medical claims processor

The differences between medical claims analysts and medical claims processors can be seen in a few details. Each job has different responsibilities and duties. While it typically takes 4-6 years to become a medical claims analyst, becoming a medical claims processor takes usually requires 2-4 years. Additionally, a medical claims analyst has an average salary of $46,708, which is higher than the $36,777 average annual salary of a medical claims processor.

The top three skills for a medical claims analyst include medical terminology, medicaid and medical insurance claims. The most important skills for a medical claims processor are patients, healthcare, and data entry.

Medical claims analyst vs medical claims processor overview

	Medical Claims Analyst	Medical Claims Processor
Yearly salary	$46,708	$36,777
Hourly rate	$22.46	$17.68
Growth rate	-6%	-3%
Number of jobs	65,897	59,992
Job satisfaction	-	-
Most common degree	Bachelor's Degree, 36%	Bachelor's Degree, 29%
Average age	44	44
Years of experience	6	4

What does a medical claims analyst do?

A medical claims analyst audits or verifies medical claims in insurance companies. Medical claims analysts make sure that corporate reimbursement payments are accurate. Usually, they work at an office on a computer workstation. They receive Medicaid claims from specialty and medical providers for reimbursement. Their job includes the development of an enhanced procedure in handling difficult Medicare/Medicaid letters while complying with the set policies.

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 claims analyst vs medical claims processor salary

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

	Medical Claims Analyst	Medical Claims Processor
Average salary	$46,708	$36,777
Salary range	Between $32,000 And $68,000	Between $29,000 And $45,000
Highest paying City	Bridgewater, NJ	Dover, DE
Highest paying state	New Jersey	Delaware
Best paying company	Montefiore Mount Vernon Hospital	Cognizant
Best paying industry	Insurance	Government

Differences between medical claims analyst and medical claims processor education

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

	Medical Claims Analyst	Medical Claims Processor
Most common degree	Bachelor's Degree, 36%	Bachelor's Degree, 29%
Most common major	Business	Business
Most common college	University of Pennsylvania	-

Medical claims analyst vs medical claims processor demographics

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

	Medical Claims Analyst	Medical Claims Processor
Average age	44	44
Gender ratio	Male, 14.2% Female, 85.8%	Male, 16.0% Female, 84.0%
Race ratio	Black or African American, 11.2% Unknown, 4.4% Hispanic or Latino, 16.4% Asian, 5.1% White, 62.4% American Indian and Alaska Native, 0.5%	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	10%	11%

Differences between medical claims analyst and medical claims processor duties and responsibilities

Medical claims analyst example responsibilities.

Manage cases by aggressively directing the litigation process.
Analyze incoming medical claims using ICD-9, CPT, HCPCS coding, and Medicare fee schedules.
Determine if claims are in compliance under patient benefit plans for payments using DRG regulations :
Review medical records to determine if the ICD-9, CPT codes and modifiers are processed correctly.
Adhere to the HIPAA privacy, security regulations, and maintain confidentiality of patient a business records.
Research medical claims issues in response to informational inquiries by accessing and interpreting EOB's and claims history.

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 claims analyst vs medical claims processor skills

Common medical claims analyst skills

Medical Terminology, 9%
Medicaid, 6%
Medical Insurance Claims, 6%
Customer Service, 6%
Data Entry, 6%
Patients, 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 Claims Analyst
Medical Claims Analyst vs Medical Claims Processor

Updated January 8, 2025

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