Medical Claims Processor: Job Description, Duties and Requirements
A career as a medical claims processor requires little formal education, though the job demands a working knowledge of the health insurance industry. Learn about the training, job duties, and certification to see if this is the right career for you.
A medical claims processor manages insurance claims from patients in doctors' offices or at insurance companies. It is the job of the claims processor to analyze and process the insurance claim, checking it for validity. Medical claims processors are not required to have any formal education, but some training courses may help to attain the recommended certification through the Certified Medical Reimbursement Specialist exam. Due to the nature of the work, it is vital that the processor be knowledgeable about the health insurance industry.
|Required Education||No formal education required, but must be knowledgeable about the health insurance industry; Certification by the Certified Medical Reimbursement Specialist (CMRS) exam highly encouraged|
|Projected Job Growth (2012-2022)*||8-14% (for insurance claims and policy processing clerks)|
|Median Salary (2013)**||$36,230 (for insurance claims and policy processing clerks)|
Source: *O*Net OnLine; **U.S. Bureau of Labor Statistics
Job Duties of a Medical Claims Processor
A medical claims processor validates the information on all medical claims from patients seeking payment from their insurance company. Claims must be thoroughly reviewed to ensure that there is no missing or incomplete information. In addition, a processor must keep meticulous records of claims and follow up on lapsed cases.
Medical claims processors are expected to have an extensive knowledge of medical terminology, as well as experience using a computer. Since medical claims processors must approve or deny payment to doctors, it is vital that they know how to correctly read and assess medical documents. Good communication skills are necessary to converse with doctors' offices or insurance companies if there is a problem with the claim.
Requirements of a Medical Claims Processor
Education Requirements for a Medical Claims Processor
There are no set educational requirements for medical claims processors. Companies may provide on-the-job training, though some previous knowledge or courses in the field may be required to enter the profession. Some schools offer vocational training or certificate programs for claims processing, which may help to start or advance a career.
It is strongly recommended that potential medical claims processors take the Certified Medical Reimbursement Specialist (CMRS) exam. According to the American Medical Billing Association, certification exhibits a dedication to professional development and aptitude in the skills necessary to succeed as a medical claims processor. The CMRS exam tests areas such as medical terminology, knowledge of medical fraud, and medical billing codes (www.ambanet.net).
Career Requirements for a Medical Claims Processor
Medical claims processing is often an entry-level position that includes on-the-job training. However, it is beneficial to have proven customer service and computer experience. Those with a previous medical background may increase their job opportunities.
Salary Info and Job Outlook
The U.S. Bureau of Labor Statistics (BLS, www.bls.gov) reported in May 2013 that the median annual salary earned by insurance claims and policy processing clerks was $36,230. Those working for general medical and surgical hospitals earned an average of $37,630 a year in 2013. The employment of such clerks was projected by O*Net OnLine to grow by 8-14% during the decade 2012-2022.
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