Medical claims processor vs claims coordinator

The differences between medical claims processors and claims coordinators 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 claims coordinator takes usually requires 4-6 years. Additionally, a claims coordinator has an average salary of $38,620, which is higher than the $36,777 average annual salary of a medical claims processor.

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

Medical claims processor vs claims coordinator overview

	Medical Claims Processor	Claims Coordinator
Yearly salary	$36,777	$38,620
Hourly rate	$17.68	$18.57
Growth rate	-3%	-6%
Number of jobs	59,992	27,332
Job satisfaction	-	-
Most common degree	Bachelor's Degree, 29%	Bachelor's Degree, 48%
Average age	44	44
Years of experience	4	6

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 claims coordinator do?

Claims coordinators are professionals who are responsible for coordinating activities that are related to handling and processing insurance claims for an organization. These coordinators must serve as liaison officer between the organization, insurance provider, and policyholders to communicate the status and eligibility for coverage for all relevant claims. They need to ensure that billing requirements are met by reviewing insurance claims. Claims coordinators must also answer all the inquiries of their clients while making recommendations to resolve any claim issues.

Medical claims processor vs claims coordinator salary

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

	Medical Claims Processor	Claims Coordinator
Average salary	$36,777	$38,620
Salary range	Between $29,000 And $45,000	Between $31,000 And $47,000
Highest paying City	Dover, DE	Federal Way, WA
Highest paying state	Delaware	New Jersey
Best paying company	Cognizant	Xcel Energy
Best paying industry	Government	Finance

Differences between medical claims processor and claims coordinator education

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

	Medical Claims Processor	Claims Coordinator
Most common degree	Bachelor's Degree, 29%	Bachelor's Degree, 48%
Most common major	Business	Business
Most common college	-	-

Medical claims processor vs claims coordinator demographics

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

	Medical Claims Processor	Claims Coordinator
Average age	44	44
Gender ratio	Male, 16.0% Female, 84.0%	Male, 24.6% Female, 75.4%
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, 11.2% Unknown, 4.4% Hispanic or Latino, 17.0% Asian, 5.3% White, 61.6% American Indian and Alaska Native, 0.5%
LGBT Percentage	11%	10%

Differences between medical claims processor and claims coordinator 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.

Claims coordinator example responsibilities.

Investigate, evaluate, and manage call to complete coverage analysis confirming or denying coverage using Xactimate estimating software.
Process and adjust Medicare claims, provide feedback to providers on proper CPT, ICD-9 coding for billing purposes.
Serve as point of contact for all legal issues relate to HIPAA.
Streamline audit procedures of TPA and maintain extremely high production rate which help in keeping staffing requirements lower.
Review and audit claims -Using correct CPT and DX codes -Denial reports -correct billing error, resubmitted claims for proper payment
Communicate with company management, injure workers/customers, medical providers and TPA, as necessary, regarding claim relate matters.

Medical claims processor vs claims coordinator skills

Common medical claims processor skills

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

Common claims coordinator skills

Customer Service, 23%
Patients, 9%
Data Entry, 8%
Phone Calls, 6%
Insurance Claims, 5%
Quality Standards, 4%

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Medical Claims Processor
Medical Claims Processor vs Claims Coordinator

Updated January 8, 2025

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