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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

  • $33,000

    Average Salary

What Does A Medical Claims Specialist Do

Medical records and health information technicians, commonly referred to as health information technicians, organize and manage health information data by ensuring that it maintains its quality, accuracy, accessibility, and security in both paper files and electronic systems. They use various classification systems to code and categorize patient information for insurance reimbursement purposes, for databases and registries, and to maintain patients’ medical and treatment histories.

Duties

Health information technicians typically do the following:

  • Review patients’ records for timeliness, completeness, accuracy, and appropriateness of data
  • Organize and maintain data for clinical databases and registries
  • Track patient outcomes for quality assessment
  • Use classification software to assign clinical codes for reimbursement and data analysis 
  • Electronically record data for collection, storage, analysis, retrieval, and reporting
  • Maintain confidentiality of patients’ records

Health information technicians document patients’ health information, including their medical history, symptoms, examination and test results, treatments, and other information about healthcare services that are provided to patients. Their duties vary by employer and by the size of the facility in which they work.

Although health information technicians do not provide direct patient care, they work regularly with registered nurses and other healthcare professionals. They meet with these workers to clarify diagnoses or to get additional information to make sure that records are complete and accurate.

The increasing adaptation and use of electronic health records (EHRs) will continue to change the job responsibilities of health information technicians. Technicians will need to be familiar with, or be able to learn, EHR computer software, follow EHR security and privacy practices, and analyze electronic data to improve healthcare information, as more healthcare providers and hospitals adopt EHR systems.

Health information technicians can specialize in many aspects of health information. Some work as medical coders, sometimes called coding specialists, or as cancer registrars.

Medical coders typically do the following:

  • Review patient information for preexisting conditions, such as diabetes
  • Assign appropriate diagnoses and procedure codes for patient care, population health statistics, and billing purposes
  • Work as a liaison between the health clinician and billing offices

Cancer registrars typically do the following:

  • Review patients’ records and pathology reports to verify completeness and accuracy
  • Assign classification codes to represent the diagnosis and treatment of cancers and benign tumors
  • Conduct annual followups to track treatment, survival, and recovery
  • Compile and analyze cancer patient information for research purposes
  • Maintain facility, regional, and national databases of cancer patients

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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.

Education

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.

Advancement

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 Career Paths

Medical Claims Specialist
Billing Specialist Team Leader Office Manager
Practice Manager
9 Yearsyrs
Billing Specialist Team Leader Case Manager
Patient Care Manager
5 Yearsyrs
Billing Specialist Team Leader Account Manager
Client Services Manager
7 Yearsyrs
Claim Specialist Claims Adjuster Office Manager
Business Office Manager
7 Yearsyrs
Claim Specialist Claims Adjuster Case Manager
Clinical Manager
8 Yearsyrs
Claim Specialist Claims Adjuster Supervisor
Unit Manager
6 Yearsyrs
Accounts Receivable Specialist Accountant Office Manager
Administrative Manager
6 Yearsyrs
Accounts Receivable Specialist Accounts Receivable Supervisor
Accounts Receivable Manager
6 Yearsyrs
Accounts Receivable Specialist Specialist Executive Assistant
Office Manager Of Human Resources
6 Yearsyrs
Medical Claims Examiner Senior Claims Examiner Case Manager
Director Of Admissions
7 Yearsyrs
Medical Claims Examiner Benefit Specialist Administrator
Nurse Manager
9 Yearsyrs
Medical Claims Examiner Benefit Specialist Property Manager
Compliance Manager
9 Yearsyrs
Claims Analyst Medical Coder Billing Manager
Revenue Manager
8 Yearsyrs
Claims Analyst Analyst Medical Coder
Health Information Manager
7 Yearsyrs
Claims Analyst Medical Coder Business Office Manager
Business Office Director
8 Yearsyrs
Specialist Lead Technician Information Technology Director
Director Of Information Management
10 Yearsyrs
Specialist Customer Service Supervisor Service Supervisor
Patient Services Manager
7 Yearsyrs
Collections Specialist Administrator Business Office Manager
Medical Records Director
5 Yearsyrs
Registered Nurse Clinic Registered Nurse Clinical Analyst
Medical Records Manager
5 Yearsyrs
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Do you work as a Medical Claims Specialist?

Help others decide if this is a good career for them

Average Length of Employment
Billing Specialist 3.0 years
Medical Collector 2.4 years
Top Careers Before Medical Claims Specialist
Cashier 6.5%
Top Careers After Medical Claims Specialist
Cashier 3.7%
Specialist 3.5%

Do you work as a Medical Claims Specialist?

Average Yearly Salary
$33,000
View Detailed Salary Report
$24,000
Min 10%
$33,000
Median 50%
$33,000
Median 50%
$33,000
Median 50%
$33,000
Median 50%
$33,000
Median 50%
$33,000
Median 50%
$33,000
Median 50%
$46,000
Max 90%
Best Paying Company
CornerStone Staffing
Highest Paying City
Baltimore, MD
Highest Paying State
Virginia
Avg Experience Level
3.3 years
How much does a Medical Claims Specialist make at top companies?
The national average salary for a Medical Claims Specialist in the United States is $33,873 per year or $16 per hour. Those in the bottom 10 percent make under $24,000 a year, and the top 10 percent make over $46,000.

How Would You Rate The Salary Of a Medical Claims Specialist?

Have you worked as a Medical Claims Specialist? Help other job seekers by rating your experience as a Medical Claims Specialist.

Top Skills for A Medical Claims Specialist

  1. Insurance Companies
  2. Medical Claims Data
  3. Healthcare
You can check out examples of real life uses of top skills on resumes here:
  • Perform quality assurance assessments regarding independent medical evaluation reports for insurance companies, TPA, and self-insured entities.
  • Input and validate medical claims data into the PCM application.
  • Explained market-specific medical and pharmaceutical benefits to member, providers and other healthcare organizations.
  • Prepare deposition and medical records summaries along with exhibits and other case-related materials for medical malpractice litigation.
  • Provided exemplary customer service by processing group disability income insurance claims in a timely and accurate manner.

Medical Claims Specialist Demographics

Gender

Female

73.1%

Male

14.2%

Unknown

12.7%
Ethnicity

White

62.6%

Hispanic or Latino

15.0%

Black or African American

12.4%

Asian

6.5%

Unknown

3.5%
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Foreign Languages Spoken

Spanish

55.6%

Carrier

8.3%

Portuguese

5.6%

Hindi

5.6%

Urdu

5.6%

Khmer

2.8%

Czech

2.8%

Hebrew

2.8%

Greek

2.8%

Slovak

2.8%

Arabic

2.8%

Italian

2.8%
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Medical Claims Specialist Education

Schools

University of Phoenix

25.9%

U.S. Career Institute

7.5%

Strayer University

7.5%

The Academy

5.4%

Walden University

4.8%

Remington College

4.8%

South University

4.1%

Kaplan University

4.1%

Wake Technical Community College

3.4%

Richland College

3.4%

University of Louisville

3.4%

Central Texas College

3.4%

Liberty University

3.4%

University of North Carolina at Greensboro

2.7%

Sullivan University

2.7%

Ashford University

2.7%

Arizona State University

2.7%

Temple University

2.7%

Harrisburg Area Community College - Harrisburg

2.7%

Ultimate Medical Academy - Clearwater

2.7%
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Majors

Business

22.6%

Health Care Administration

21.7%

Nursing

7.5%

Medical Assisting Services

6.1%

Accounting

5.0%

Criminal Justice

4.6%

Management

4.5%

Psychology

4.2%

Insurance

2.9%

General Studies

2.8%

Marketing

2.4%

Computer Science

1.9%

Legal Support Services

1.9%

Liberal Arts

1.9%

Computer Information Systems

1.8%

Education

1.7%

Political Science

1.7%

Medical Technician

1.7%

Public Health

1.5%

Human Resources Management

1.5%
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Degrees

Other

28.9%

Bachelors

27.8%

Associate

18.6%

Certificate

9.9%

Masters

7.5%

Diploma

5.4%

Doctorate

1.2%

License

0.8%
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