Medical claims specialist vs medical billing clerk

The differences between medical claims specialists and medical billing clerks can be seen in a few details. Each job has different responsibilities and duties. While it typically takes 6-12 months to become a medical claims specialist, becoming a medical billing clerk takes usually requires 1-2 years. Additionally, a medical claims specialist has an average salary of $35,706, which is higher than the $33,566 average annual salary of a medical billing clerk.

The top three skills for a medical claims specialist include customer service, patients and medicaid. The most important skills for a medical billing clerk are patients, medical billing, and healthcare.

Medical claims specialist vs medical billing clerk overview

	Medical Claims Specialist	Medical Billing Clerk
Yearly salary	$35,706	$33,566
Hourly rate	$17.17	$16.14
Growth rate	11%	-3%
Number of jobs	82,897	164,870
Job satisfaction	-	-
Most common degree	Bachelor's Degree, 38%	Associate Degree, 30%
Average age	45	46
Years of experience	12	2

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 billing clerk do?

A medical billing clerk is primarily in charge of processing payments and creating billing arrangements in clinics and hospitals. Among their responsibilities include gathering and verifying patient identification, handling insurance information, coding, updating databases, and maintaining records. It is also their responsibility to assist patients by filling out forms, answering their inquiries, and referring them to other services. Moreover, a medical billing clerk must monitor patient accounts and follow-up on delinquent patient accounts, coordinating with collection agencies as needed.

Medical claims specialist vs medical billing clerk salary

Medical claims specialists and medical billing clerks have different pay scales, as shown below.

	Medical Claims Specialist	Medical Billing Clerk
Average salary	$35,706	$33,566
Salary range	Between $28,000 And $43,000	Between $27,000 And $40,000
Highest paying City	Attleboro, MA	San Leandro, CA
Highest paying state	Connecticut	Washington
Best paying company	Total Medical Personnel Staffing	iCare
Best paying industry	Government	Health Care

Differences between medical claims specialist and medical billing clerk education

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

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

Medical claims specialist vs medical billing clerk demographics

Here are the differences between medical claims specialists' and medical billing clerks' demographics:

	Medical Claims Specialist	Medical Billing Clerk
Average age	45	46
Gender ratio	Male, 16.7% Female, 83.3%	Male, 11.3% Female, 88.7%
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, 10.4% Unknown, 4.3% Hispanic or Latino, 21.9% Asian, 6.8% White, 55.8% American Indian and Alaska Native, 0.8%
LGBT Percentage	9%	7%

Differences between medical claims specialist and medical billing clerk 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 billing clerk example responsibilities.

Accept and process healthcare claims and confidential medical records; verify patient eligibility and manage the Medicare and Medicaid billing process.
Interact with patients as part of the quality assurance process (follow-up, EHR confirmation, billing confirmation).
Reconcile insurance and patient payments while researching and resolving incorrect payments, EOB rejections, and assort issues with outstanding accounts.
Utilize medical terminology and follow HIPAA guidelines.
Bill Magellan through Nextgen system.
Double checked CMS-1500 form before posting it out to the insurance companies.

Medical claims specialist vs medical billing clerk skills

Common medical claims specialist skills

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

Common medical billing clerk skills

Patients, 18%
Medical Billing, 10%
Healthcare, 7%
Data Entry, 7%
Customer Service, 6%
Medicaid, 5%

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Healthcare Practitioner and Technical Industry
Medical Claims Specialist
Medical Claims Specialist vs Medical Billing Clerk

Updated January 8, 2025

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