Medical claims specialist vs medical coder

The differences between medical claims specialists and medical 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 coder. Additionally, a medical coder has an average salary of $51,563, 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 coder are CPC, medical terminology, and ICD-10-CM.

Medical claims specialist vs medical coder overview

	Medical Claims Specialist	Medical Coder
Yearly salary	$35,706	$51,563
Hourly rate	$17.17	$24.79
Growth rate	11%	11%
Number of jobs	82,897	51,316
Job satisfaction	-	-
Most common degree	Bachelor's Degree, 38%	Associate Degree, 37%
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 coder do?

A medical coder's role is to interpret and analyze a patient's medical record and translate particular details according to the universal medical alphanumeric code. Moreover, a medical coder is primarily responsible for ensuring that the translations are accurate, as this will play a vital factor in processing insurance and receiving treatments. Aside from accuracy, it is also crucial for a medical coder to coordinate with other hospital personnel at all times, especially when there inconsistencies in the records.

Medical claims specialist vs medical coder salary

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

	Medical Claims Specialist	Medical Coder
Average salary	$35,706	$51,563
Salary range	Between $28,000 And $43,000	Between $37,000 And $70,000
Highest paying City	Attleboro, MA	Trenton, NJ
Highest paying state	Connecticut	Hawaii
Best paying company	Total Medical Personnel Staffing	Meta
Best paying industry	Government	Health Care

Differences between medical claims specialist and medical coder education

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

	Medical Claims Specialist	Medical Coder
Most common degree	Bachelor's Degree, 38%	Associate Degree, 37%
Most common major	Business	Health Care Administration
Most common college	University of Pennsylvania	Stanford University

Medical claims specialist vs medical coder demographics

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

	Medical Claims Specialist	Medical Coder
Average age	45	45
Gender ratio	Male, 16.7% Female, 83.3%	Male, 13.2% Female, 86.8%
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, 9.2% Unknown, 4.2% Hispanic or Latino, 16.2% Asian, 9.0% White, 60.1% American Indian and Alaska Native, 1.3%
LGBT Percentage	9%	9%

Differences between medical claims specialist and medical 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 coder example responsibilities.

Manage all EDI relate communication with trading partners and assist to produce all operational documents for all end users.
Manage all aspects of AR including writing letters for medical necessity, claim denials, bundling issues and charge capture.
Manage health records while applying ICD-10 coding to update and process insurance claims for time and accuracy to various insurance companies.
Manage the outsourced transcription company.
Create documentation education classes to general surgery residents, increasing the leveling of reporting which lead to increase revenues.
Adhere to regulations with CPT-4, ICD-9-CM and HCPCS coding with medical terminology and effort meet all audit requirements.

Medical claims specialist vs medical 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 coder skills

CPC, 11%
Medical Terminology, 8%
ICD-10-CM, 7%
AHIMA, 7%
Patients, 7%
Clinical Documentation, 5%

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Medical Claims Specialist
Medical Claims Specialist vs Medical Coder

Updated January 8, 2025

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