Medical claims specialist vs medical biller coder

The differences between medical claims specialists and medical biller coders can be seen in a few details. Each job has different responsibilities and duties. It typically takes 6-12 months to become both a medical claims specialist and a medical biller coder. Additionally, a medical biller coder has an average salary of $38,756, which is higher than the $35,706 average annual salary of a medical claims specialist.

The top three skills for a medical claims specialist include customer service, patients and medicaid. The most important skills for a medical biller coder are patients, medical billing, and ICD-10.

Medical claims specialist vs medical biller coder overview

	Medical Claims Specialist	Medical Biller Coder
Yearly salary	$35,706	$38,756
Hourly rate	$17.17	$18.63
Growth rate	11%	11%
Number of jobs	82,897	54,861
Job satisfaction	-	5
Most common degree	Bachelor's Degree, 38%	Associate Degree, 30%
Average age	45	45
Years of experience	12	12

What does a medical claims specialist do?

A medical claims specialist is responsible for gathering and processing the information required to complete the medical insurance claims process. Typical duties include determining covered medical insurance losses, documenting medical claims actions, and resolving claims through approval or denial of documentation. In addition, you will be responsible for maintaining excellent customer service by responding to customer inquiries and following best practices. You will also be responsible for protecting company operations by maintaining the confidentiality of information.

What does a medical biller coder do?

A medical biller coder is responsible for handling the billing processes and insurance within a hospital, clinic, or similar facility. They must gather patient information and records to analyze and translate them into codes according to the insurance and medical guidelines. Moreover, it is crucial to verify all patient forms and ensure their accuracy as it will serve as a basis on essential documents and medical record-keeping. There may also be instances where a medical biller coder must devise payment plans for patients, communicate with families and guardians, and coordinate with physicians.

Medical claims specialist vs medical biller coder salary

Medical claims specialists and medical biller coders have different pay scales, as shown below.

	Medical Claims Specialist	Medical Biller Coder
Average salary	$35,706	$38,756
Salary range	Between $28,000 And $43,000	Between $30,000 And $49,000
Highest paying City	Attleboro, MA	San Francisco, CA
Highest paying state	Connecticut	California
Best paying company	Total Medical Personnel Staffing	University of California, Berkeley
Best paying industry	Government	Professional

Differences between medical claims specialist and medical biller coder education

There are a few differences between a medical claims specialist and a medical biller coder in terms of educational background:

	Medical Claims Specialist	Medical Biller Coder
Most common degree	Bachelor's Degree, 38%	Associate Degree, 30%
Most common major	Business	Health Care Administration
Most common college	University of Pennsylvania	University of Pennsylvania

Medical claims specialist vs medical biller coder demographics

Here are the differences between medical claims specialists' and medical biller coders' demographics:

	Medical Claims Specialist	Medical Biller Coder
Average age	45	45
Gender ratio	Male, 16.7% Female, 83.3%	Male, 10.0% Female, 90.0%
Race ratio	Black or African American, 9.5% Unknown, 4.2% Hispanic or Latino, 17.0% Asian, 8.3% White, 59.8% American Indian and Alaska Native, 1.3%	Black or African American, 9.3% Unknown, 4.2% Hispanic or Latino, 17.8% Asian, 8.0% White, 59.5% American Indian and Alaska Native, 1.3%
LGBT Percentage	9%	9%

Differences between medical claims specialist and medical biller coder duties and responsibilities

Medical claims specialist example responsibilities.

Apply Medicare, Medicaid billing guidelines to achieve maximum reimbursement.
Detail knowledge of medical coding; ICD-9, CPT and HCPCS codes.
Confirm coverage and work with private payers, commercial payers, Medicaid, and Medicare for reimbursement of provide medical services.
Research medical records, compliance requirements and explanations of benefits to resolve accounts payable for Medicare, Medicaid and commercial insurance.
Maintain strict confidentiality/privacy of patients' protect health information in accordance with HIPAA regulations.
Assist in educating new hires in HIPPA laws and training.

Medical biller coder example responsibilities.

Manage chart completion (ICD-9-CM and CPT coding), chart assembly and analysis and patient information privacy/security.
Use EMR software to manage patient records and files reinforce and uphold patient confidentiality as required by HIPAA and clinic.
Manage chart completion (ICD-9-CM and CPT coding/abstracting), chart assembly and analysis, patient admission and patient information privacy/security.
Bill insurance claims using HCFA 1500 and UB-92 form.
Review coding, verify the diagnosis codes (ICD-9) and procedure codes (CPT) are congruent and clinically appropriate.
Have experience in all commercial insurances and government insurances including Medicare and Medicaid.

Medical claims specialist vs medical biller coder skills

Common medical claims specialist skills

Customer Service, 14%
Patients, 9%
Medicaid, 7%
Medical Billing, 6%
Phone Calls, 6%
Medical Terminology, 5%

Common medical biller coder skills

Patients, 17%
Medical Billing, 5%
ICD-10, 5%
Customer Service, 5%
CPT-4, 4%
HCPCS, 4%

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Medical Claims Specialist vs Medical Biller Coder

Updated January 8, 2025

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