Medical claims processor vs billing representative

The differences between medical claims processors and billing representatives can be seen in a few details. Each job has different responsibilities and duties. While it typically takes 2-4 years to become a medical claims processor, becoming a billing representative takes usually requires 1-2 years. Additionally, a medical claims processor has an average salary of $36,777, which is higher than the $35,002 average annual salary of a billing representative.

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

Medical claims processor vs billing representative overview

	Medical Claims Processor	Billing Representative
Yearly salary	$36,777	$35,002
Hourly rate	$17.68	$16.83
Growth rate	-3%	-3%
Number of jobs	59,992	95,425
Job satisfaction	-	-
Most common degree	Bachelor's Degree, 29%	Bachelor's Degree, 30%
Average age	44	46
Years of experience	4	2

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.

What does a billing representative do?

A billing representative assists with the overall operations of the organization's billing department. Billing representatives post payments timely on the database, update account statements, generate financial reports, release invoices, and resolve account discrepancies. They also perform client accounts reconciliation as needed, monitor account receivables, review overdated balance, and notify clients of payment updates to ensure accurate and timely billing. A billing representative must have strong analytical and communication skills to manage clients' accounts, as well as comprehensive knowledge on the accounting industry to explain the payment terms and policies of an organization to a client.

Medical claims processor vs billing representative salary

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

	Medical Claims Processor	Billing Representative
Average salary	$36,777	$35,002
Salary range	Between $29,000 And $45,000	Between $28,000 And $42,000
Highest paying City	Dover, DE	Worcester, MA
Highest paying state	Delaware	Massachusetts
Best paying company	Cognizant	Relevante
Best paying industry	Government	Technology

Differences between medical claims processor and billing representative education

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

	Medical Claims Processor	Billing Representative
Most common degree	Bachelor's Degree, 29%	Bachelor's Degree, 30%
Most common major	Business	Business
Most common college	-	Stanford University

Medical claims processor vs billing representative demographics

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

	Medical Claims Processor	Billing Representative
Average age	44	46
Gender ratio	Male, 16.0% Female, 84.0%	Male, 15.7% Female, 84.3%
Race ratio	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%	Black or African American, 10.4% Unknown, 4.3% Hispanic or Latino, 19.9% Asian, 7.3% White, 57.2% American Indian and Alaska Native, 0.9%
LGBT Percentage	11%	7%

Differences between medical claims processor and billing representative duties and responsibilities

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.

Billing representative example responsibilities.

Manage software programs for MSP accounts, monthly billing and EMC file transfers to Medicare.
Accept and process healthcare claims and confidential medical records; verify patient eligibility and manage the Medicare and Medicaid billing process.
Process orders in compliance with Medicare, Medicaid and private insurance verification guidelines; confirming customer's eligibility and insurance coverage.
Verify insurance eligibility for schedule appointments, and verify cash pricing for private pay patients who request cost by CPT code.
Submit and receive Medicare and Medicaid claims electronically on a daily basis.
Utilize extensive computer skills and coding knowledge to produce and submit physical therapy and occupational therapy claims through medicaid and medicare.

Medical claims processor vs billing representative skills

Common medical claims processor skills

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

Common billing representative skills

Patients, 18%
Customer Service, 13%
Data Entry, 6%
Medical Billing, 5%
Medicaid, 5%
Patient Accounts, 4%

Medical Claims Processor vs. similar jobs

Medical Claims Processor related careers

Medical Claims Processor related jobs

What similar roles do

Zippia Careers
Office and Administrative Industry
Medical Claims Processor
Medical Claims Processor vs Billing Representative

Updated January 8, 2025

Browse office and administrative jobs