Medical claims specialist vs reimbursement specialist

The differences between medical claims specialists and reimbursement specialists 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 reimbursement specialist. Additionally, a reimbursement specialist has an average salary of $38,273, 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 reimbursement specialist are patients, customer service, and appeals.

Medical claims specialist vs reimbursement specialist overview

	Medical Claims Specialist	Reimbursement Specialist
Yearly salary	$35,706	$38,273
Hourly rate	$17.17	$18.40
Growth rate	11%	11%
Number of jobs	82,897	32,292
Job satisfaction	-	-
Most common degree	Bachelor's Degree, 38%	Bachelor's Degree, 40%
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 reimbursement specialist do?

A reimbursement specialist is responsible for analyzing insurance documents, processing reimbursement claims, and releasing accurate billing statements for insurance claims. Reimbursement specialists must have excellent analytical skills, especially on performing clerical tasks to evaluate insurance cases, investigate cases, and update the account information of the clients on the database. They should also have impeccable communication skills and understanding of the insurance processes to be able to coordinate with the clients, explaining the procedures of their claims accurately, and coordinate with the insurance management to improve the claims processes.

Medical claims specialist vs reimbursement specialist salary

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

	Medical Claims Specialist	Reimbursement Specialist
Average salary	$35,706	$38,273
Salary range	Between $28,000 And $43,000	Between $29,000 And $49,000
Highest paying City	Attleboro, MA	Lynchburg, VA
Highest paying state	Connecticut	Virginia
Best paying company	Total Medical Personnel Staffing	Novartis
Best paying industry	Government	Pharmaceutical

Differences between medical claims specialist and reimbursement specialist education

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

	Medical Claims Specialist	Reimbursement Specialist
Most common degree	Bachelor's Degree, 38%	Bachelor's Degree, 40%
Most common major	Business	Business
Most common college	University of Pennsylvania	University of Pennsylvania

Medical claims specialist vs reimbursement specialist demographics

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

	Medical Claims Specialist	Reimbursement Specialist
Average age	45	45
Gender ratio	Male, 16.7% Female, 83.3%	Male, 15.2% Female, 84.8%
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, 9.8% Unknown, 4.2% Hispanic or Latino, 16.9% Asian, 8.1% White, 59.8% American Indian and Alaska Native, 1.3%
LGBT Percentage	9%	9%

Differences between medical claims specialist and reimbursement specialist 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.

Reimbursement specialist example responsibilities.

Manage the EDI clearinghouse rejections.
Process department payroll, order supplies, and manage petty-cash funds.
Manage use of various systems, such as MEDITECH, Cerner, WebNow, and yield-base follow-up tool.
Manage cases by aggressively directing the litigation process.
Negotiate fee structure for manage care contracts on acute and rehabilitation facilities.
Research medical coding ICD-9, ICD-10, HCPCS and CPT-4 to let client know the outcome of medical claim.

Medical claims specialist vs reimbursement specialist skills

Common medical claims specialist skills

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

Common reimbursement specialist skills

Patients, 20%
Customer Service, 9%
Appeals, 6%
CPT, 5%
Medicare, 4%
Medicaid, 4%

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Medical Claims Specialist
Medical Claims Specialist vs Reimbursement Specialist

Updated January 8, 2025

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