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Become A Medical Claims Specialist

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Working As A Medical Claims Specialist

  • Getting Information
  • Processing Information
  • Documenting/Recording Information
  • Interacting With Computers
  • Organizing, Planning, and Prioritizing Work
  • Mostly Sitting

  • Repetitive

  • $37,110

    Average Salary

What Does A Medical Claims Specialist Do At Robert Half

* Perform accounts receivable aging reviews and prioritize collection efforts based on aging and balance Analyzes the claim, explanation of benefits, correspondence, payer website and/or any additional information necessary to identify the next appropriate action toward account resolution.
* Research and resolve underpayments
* Follows government and third party payer guidelines to ensure complete and timely follow-up on claims that have open balances, were rejected, or denied.
* Performs appeals by following government and third party payer appeals guidelines.
* Reviews payer contracts and fee schedules to perform underpayment appeals.
* Works to identify other payers when possible and ensures all payers and filing order is current in the registration application.
* Collaborates with the Supervisor/Lead to identify patterns and interpret denial trends, and notifies Supervisor when insurance plans deny services, which are covered based on the contract terms or government guidelines

What Does A Medical Claims Specialist Do At Unitedhealth Group

Training of functional areas such as Claims or Customer Service individuals in the Training Delivery Operational functions Research / analyze data needed to identify/confirm business issues (e.g., quality data, production data) Conduct task analysis / research to identify the specific knowledge, skills, behaviors needed to achieve desired performance levels (e.g., assessments, focus groups, observation) Engage / collaborate with appropriate stakeholders and SME's to determine appropriate training content (e.g

What Does A Medical Claims Specialist Do At Kforce

Logging Provider appeals

What Does A Medical Claims Specialist Do At Robert Half

* Input and validate medical claims data into the PCM application.
* Analyze rejected claims data
* Review documentation authorizing benefits payments.
* Determine appropriate amount due to recipient and process all necessary payment transactions.
* Analyze and audit any overpayments of claims.
* Record and issue letters informing debtors of obligations.
* Respond to written and oral vendor inquiries; follow up as needed

What Does A Medical Claims Specialist Do At Robert Half

Adjudicating claims using standard principles and state specific policies and regulations

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How To Become A Medical Claims Specialist

Health information technicians typically need a postsecondary certificate to enter the occupation, although some may need an associate’s degree. Certification is often required.


Postsecondary certificate and associate’s degree programs in health information technology typically include courses in medical terminology, anatomy and physiology, health data requirements and standards, classification and coding systems, healthcare reimbursement methods, healthcare statistics, and computer systems. Applicants to health information technology programs may increase their chances of admission by taking high school courses in health, computer science, math, and biology.

A high school diploma or equivalent and previous experience in a healthcare setting are enough to qualify for some positions, but most jobs for health information technicians require postsecondary education.

Important Qualities

Analytical skills. Health information technicians must be able to understand and follow medical records and diagnoses, and then decide how best to code them in a patient’s medical records.

Detail oriented. Health information technicians must be accurate when recording and coding patient information.

Integrity. Health information technicians work with patient data that are required, by law, to be kept confidential. They must exercise caution and a strong sense of ethics when working with this information in order to protect patient confidentiality.

Interpersonal skills. Health information technicians need to be able to discuss patient information, discrepancies, and data requirements with other professionals such as physicians and finance personnel.

Technical skills. Health information technicians must be able to use coding and classification software and the electronic health record (EHR) system that their healthcare organization or physician practice has adopted.

Licenses, Certifications, and Registrations

Most employers prefer to hire health information technicians who have certification, or they may expect applicants to earn certification shortly after being hired. A health information technician can earn certification from several organizations. Certifications include the Registered Health Information Technician (RHIT) and the Certified Tumor Registrar (CTR), among others.

Some organizations base certification on passing an exam. Others require graduation from an accredited program. Many coding certifications also require coding experience in a work setting. Once certified, technicians typically must renew their certification regularly and take continuing education courses.

A few states and facilities require cancer registrars to be licensed. Licensure requires the completion of a formal education program and the Certified Tumor Registrar (CTR) certification.


Health information technicians may advance to other health information positions by receiving additional education and certifications. Technicians may be able to advance to a position as a medical or health services manager after completing a bachelor’s or master’s degree program and taking the required certification courses. Requirements vary by facility.

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Medical Claims Specialist jobs

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Medical Claims Specialist Demographics


  • Female

  • Male

  • Unknown



  • White

  • Hispanic or Latino

  • Asian

  • Unknown

  • Black or African American

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Languages Spoken

  • Spanish

  • Carrier

  • Hindi

  • Urdu

  • Portuguese

  • Slovak

  • Arabic

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Medical Claims Specialist

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Medical Claims Specialist Education

Medical Claims Specialist

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Top Skills for A Medical Claims Specialist


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Top Medical Claims Specialist Skills

  1. Medical Claims Data
  2. Quality Customer Services
  3. Medical Treatment
You can check out examples of real life uses of top skills on resumes here:
  • Input and validate medical claims data into the PCM application.
  • Authorized minor medical treatment and followed up with physician for compliance.
  • Researched numerous documents according to AZ State Medicaid and applying to appropriate medical claims type.
  • Performed data entry to register medical claims into a proprietary database.
  • Position required thorough knowledge of CMS and UB92 claims forms, ICD-9, CPT-4, HCPC and RCC coding practices.

Top Medical Claims Specialist Employers

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Medical Claims Specialist Videos

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