Medical Claims Processor: Job Description, Duties and Requirements

Medical claims processors work in doctors' offices or at insurance companies to handle insurance claims from patients. 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.

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Medical Claims Processor Job Description

A medical claims processor manages and processes insurance claims. When healthcare providers treat patients, they file a medical claim to receive payment from the patient's insurance company. The medical claims processor then reviews and assesses the claim, remitting payment to the doctor if a claim is covered by the patient's insurance policy. Due to the nature of the work, it is vital that the processor be knowledgeable about the health insurance industry.

Job Duties of a Medical Claims Processor

A medical claims processor needs to validate the information on all medical claims received. Claims must be thoroughly reviewed and 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 expansive 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 the BLS to grow about 8.% between 2012 and 2022.

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