Medicare billing specialist vs billing representative

The differences between medicare billing specialists and billing representatives can be seen in a few details. Each job has different responsibilities and duties. It typically takes 1-2 years to become both a medicare billing specialist and a billing representative. Additionally, a medicare billing specialist has an average salary of $36,773, which is higher than the $35,002 average annual salary of a billing representative.

The top three skills for a medicare billing specialist include patients, patient accounts and data entry. The most important skills for a billing representative are patients, customer service, and data entry.

Medicare billing specialist vs billing representative overview

	Medicare Billing Specialist	Billing Representative
Yearly salary	$36,773	$35,002
Hourly rate	$17.68	$16.83
Growth rate	-3%	-3%
Number of jobs	54,593	95,425
Job satisfaction	-	-
Most common degree	Associate Degree, 34%	Bachelor's Degree, 30%
Average age	46	46
Years of experience	2	2

Medicare billing specialist vs billing representative salary

Medicare billing specialists and billing representatives have different pay scales, as shown below.

	Medicare Billing Specialist	Billing Representative
Average salary	$36,773	$35,002
Salary range	Between $30,000 And $44,000	Between $28,000 And $42,000
Highest paying City	-	Worcester, MA
Highest paying state	-	Massachusetts
Best paying company	-	Relevante
Best paying industry	-	Technology

Differences between medicare billing specialist and billing representative education

There are a few differences between a medicare billing specialist and a billing representative in terms of educational background:

	Medicare Billing Specialist	Billing Representative
Most common degree	Associate Degree, 34%	Bachelor's Degree, 30%
Most common major	Business	Business
Most common college	University of Pennsylvania	Stanford University

Medicare billing specialist vs billing representative demographics

Here are the differences between medicare billing specialists' and billing representatives' demographics:

	Medicare Billing Specialist	Billing Representative
Average age	46	46
Gender ratio	Male, 9.3% Female, 90.7%	Male, 15.7% Female, 84.3%
Race ratio	Black or African American, 10.3% Unknown, 4.4% Hispanic or Latino, 16.5% Asian, 7.9% White, 59.8% American Indian and Alaska Native, 1.0%	Black or African American, 10.4% Unknown, 4.3% Hispanic or Latino, 19.9% Asian, 7.3% White, 57.2% American Indian and Alaska Native, 0.9%
LGBT Percentage	7%	7%

Differences between medicare billing specialist and billing representative duties and responsibilities

Medicare billing specialist example responsibilities.

Accept and process healthcare claims and confidential medical records; verify patient eligibility and manage the Medicare and Medicaid billing process.
Resolve billing issues, ensure accuracy re: CPT, HCPCS, ICD-9 codes as applicable.
Expand knowledge with insurance EOB & Tennessee Medicare (handle denials and some occurring problems )
Call Medicare to re-open claims due to date, CPT, units, or other changes.
Used CPT-4 coders/Modifiers, ICD-9 codes, HCPCS codes when applicable for the resolution of claim payments.
Comply with all HIPPA laws.

Billing representative example responsibilities.

Manage software programs for MSP accounts, monthly billing and EMC file transfers to Medicare.
Accept and process healthcare claims and confidential medical records; verify patient eligibility and manage the Medicare and Medicaid billing process.
Process orders in compliance with Medicare, Medicaid and private insurance verification guidelines; confirming customer's eligibility and insurance coverage.
Verify insurance eligibility for schedule appointments, and verify cash pricing for private pay patients who request cost by CPT code.
Submit and receive Medicare and Medicaid claims electronically on a daily basis.
Utilize extensive computer skills and coding knowledge to produce and submit physical therapy and occupational therapy claims through medicaid and medicare.

Medicare billing specialist vs billing representative skills

Common medicare billing specialist skills

Patients, 20%
Patient Accounts, 6%
Data Entry, 5%
Medicare, 5%
Medicaid, 5%
CPT, 5%

Common billing representative skills

Patients, 18%
Customer Service, 13%
Data Entry, 6%
Medical Billing, 5%
Medicaid, 5%
Patient Accounts, 4%

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Medicare Billing Specialist
Medicare Billing Specialist vs Billing Representative

Updated January 8, 2025

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