Top 11 Claims Processor Certifications

Certifications are important for a claims processor in the job market because they demonstrate that the individual has the knowledge and skills necessary to perform the job. Certifications provide employers with assurance that the individual is qualified to handle claims processing efficiently and effectively. They also demonstrate that the individual is committed to their professional development, which can be attractive to employers. Finally, certifications can give a claims processor an edge over other applicants who may not have them, as certifications often signify expertise in a particular area of insurance.

The purpose of this article is to review the top certifications for Claims Processors and explain how they can help advance a Claims Processor's career.

What are Claims Processor Certifications?

Claims processor certification is a professional credential that demonstrates a person’s knowledge and proficiency in the processing of medical claims. It is typically offered by organizations such as the American Academy of Professional Coders (AAPC) or the American Health Information Management Association (AHIMA). The certification is widely recognized by employers in the healthcare industry and can be beneficial to those looking for careers in medical billing, coding, insurance claims processing, and other related fields.

Claims processor certification requires passing an examination that covers topics such as medical terminology, legal and ethical aspects of health information management, coding systems, reimbursement methodologies, managing files for accuracy and completeness, and other relevant topics. Having this certification demonstrates to employers that an individual has acquired the necessary skills to perform these tasks accurately and efficiently. Furthermore, certified claims processors are often seen as more knowledgeable than their non-certified counterparts. This can lead to increased job opportunities and higher salaries within the field.

Pro Tip: Before you begin the claims processor certification process, make sure to research the requirements and best practices of your state's insurance board. This will help ensure that your application is complete and accurate, increasing your chances of receiving certification.

Related: What does a Claims Processor do?

Top 11 Claims Processor Certifications

Here’s our list of the best certifications available to Claims Processors today.

1. Certified Professional Coder (CPC)

Certified Professional Coder (CPC) is a certification offered by the American Academy of Professional Coders (AAPC). It is designed to recognize individuals who have demonstrated proficiency in medical coding, which involves assigning codes to diagnoses and procedures for billing purposes. The CPC certification is the most widely recognized and respected credential for medical coders.

It typically takes about six months to prepare for the CPC exam. This includes studying for the exam and taking practice tests to ensure you understand the material. The cost of the exam varies depending on if you are an AAPC member or not, but it generally ranges from $300 - $400 USD. To get certified, you must pass the CPC exam with a score of 70% or higher.

The cost of becoming a CPC includes the cost of joining AAPC ($50-$100 USD), purchasing study materials ($50-$150 USD), and taking the exam ($300-$400 USD). In total, it can cost anywhere from $400 - $650 USD to become a Certified Professional Coder (CPC).

2. Certified Professional Medical Biller (CPMA)

Certified Professional Medical Biller (CPMA) is a professional certification that demonstrates an individual’s knowledge and proficiency in medical billing. It is a voluntary certification offered by the American Academy of Professional Coders (AAPC). To become certified, applicants must pass an exam that covers topics such as medical coding, reimbursement methodologies, and healthcare compliance.

The CPMA exam typically takes about two to three hours to complete and consists of 150 multiple-choice questions. Applicants must have at least one year of experience in medical billing or coding in order to be eligible for the CPMA exam.

To get the CPMA certification, applicants must register with AAPC and pay a $399 fee. This fee includes the cost of the exam, study materials, and a one-year membership in AAPC. After registering with AAPC, applicants can take the CPMA exam at any approved testing center across the United States. Once they pass the exam, they will receive their official CPMA certificate from AAPC.

The CPMA certification is valid for three years after which time it must be renewed by taking continuing education courses or retaking the exam. The renewal fee is $199 and includes access to updated study materials and a one-year membership in AAPC.

3. Certified Revenue Cycle Representative (CRCR)

A Certified Revenue Cycle Representative (CRCR) is a professional certification that recognizes individuals who have demonstrated mastery of the principles and practices of revenue cycle management. The CRCR certification is offered by the American Academy of Professional Coders (AAPC).

To become certified as a CRCR, applicants must successfully complete an online exam. The exam consists of 150 multiple-choice questions covering topics such as medical billing, coding, accounts receivable management, compliance standards, and more. The exam takes approximately three hours to complete.

In order to be eligible for the CRCR certification, applicants must have at least two years of experience in revenue cycle management or equivalent education. Additionally, applicants must pass a background check and pay an application fee.

The cost for the CRCR certification is $299 for AAPC members and $399 for non-members. This cost covers the application fee and the cost of taking the exam.

4. Certified Medical Reimbursement Specialist (CMRS)

A Certified Medical Reimbursement Specialist (CMRS) is a professional who specializes in medical billing and coding. The CMRS credential is awarded by the American Academy of Professional Coders (AAPC). This certification demonstrates that an individual has mastered the knowledge and skills necessary to accurately process medical claims, interpret insurance policies, and maximize reimbursement for healthcare services.

It typically takes an individual between 3-6 months to study for and pass the CMRS exam. To get certified, individuals must first become a member of the AAPC and then register for the exam. The cost of membership varies depending on which type of membership you choose, but typically ranges from $50-$200. The cost of the exam itself is $399 for members and $499 for non-members.

5. Certified Healthcare Financial Professional (CHFP)

The Certified Healthcare Financial Professional (CHFP) is a professional certification offered by the Healthcare Financial Management Association (HFMA). It is designed to recognize individuals who have demonstrated knowledge and expertise in healthcare finance. The CHFP credential is recognized as a mark of excellence in the field of healthcare finance and provides an opportunity for healthcare financial professionals to demonstrate their commitment to professional development and excellence.

To earn the CHFP credential, applicants must pass a comprehensive exam that covers topics such as financial management, reimbursement, budgeting, accounting, and legal/regulatory issues. Applicants must also meet certain educational requirements, including a minimum of two years of full-time healthcare finance experience or equivalent part-time experience.

The exam takes approximately three hours to complete and consists of 150 multiple-choice questions. The cost for the exam is $450 for HFMA members ($550 for non-members). After passing the exam, applicants will receive their CHFP credential within four weeks.

6. Certified Healthcare Access Manager (CHAM)

Certified Healthcare Access Manager (CHAM) is a certification program offered by the National Association of Healthcare Access Management (NAHAM). It is designed to recognize individuals who demonstrate excellence in healthcare access management. The CHAM designation is a nationally recognized credential that acknowledges the knowledge and skills required for effective healthcare access management.

The CHAM program consists of an online exam, which covers topics such as: patient scheduling, registration, insurance verification, customer service, revenue cycle management, and data analysis. To become certified, applicants must pass the exam with a score of at least 80%. The exam typically takes 2-3 hours to complete and can be taken at any Pearson VUE testing center or online.

The cost of the certification program varies depending on whether you are an NAHAM member or nonmember. For members, the cost is $250; for nonmembers it is $350. Additionally, there is a one-time application fee of $50 for both members and nonmembers.

Overall, obtaining your CHAM certification requires passing an exam and paying the associated fees. It can take up to two weeks to receive your results after taking the exam. Once you have passed the exam and paid all applicable fees, you will receive your official CHAM certificate in four to six weeks.

7. Certified Professional Compliance Officer (CPCO)

Certified Professional Compliance Officer (CPCO) is a professional certification program designed to provide compliance professionals with the knowledge and skills necessary to effectively manage and oversee regulatory compliance programs. The certification is offered by the Association of Certified Professional Compliance Officers (ACPCO).

The CPCO program requires completion of two phases: a self-study phase and an examination phase. During the self-study phase, candidates must complete a comprehensive study guide that covers topics including ethics, risk management, legal requirements, and regulatory compliance. After completing the self-study phase, candidates must pass an online exam consisting of multiple choice questions.

To become certified as a CPCO, applicants must have at least three years of experience in the field of compliance or related fields such as law or accounting. In addition, applicants must submit an application form along with their resume and proof of experience. Once approved for certification, applicants will be required to pay a one-time fee of $495 USD plus applicable taxes.

Once certified, CPCOs are expected to maintain their certification through continuing education activities such as attending conferences and webinars or taking additional courses related to regulatory compliance. Additionally, CPCOs may be required to renew their certification every three years in order to remain valid.

8. Certified Health Insurance Executive (CHIE)

Certified Health Insurance Executive (CHIE) is a professional certification program designed to recognize individuals who have achieved a high level of expertise in the health insurance industry. The CHIE certification is offered by the American College of Healthcare Executives (ACHE). It is recognized as the premier credential for health insurance executives and provides an opportunity for those in the field to demonstrate their commitment to excellence.

The CHIE certification requires applicants to have at least five years of experience in health insurance management and/or policy development, as well as a bachelor’s degree or higher. Applicants must also pass an examination that covers topics such as health care finance, risk management, legal issues, and customer service.

The process of obtaining the CHIE certification typically takes three to six months from start to finish. The first step is submitting an application to ACHE along with proof of education and work experience. Once accepted, applicants are required to pass a two-part exam that consists of multiple-choice questions and case studies. After passing the exam, applicants will receive their official certificate within four weeks.

The cost of obtaining the CHIE certification varies depending on factors such as membership status with ACHE and whether or not one has taken any preparatory courses prior to taking the exam. In general, it can range anywhere from $400-$800.

9. American Academy of Professional Coders (AAPC)

The American Academy of Professional Coders (AAPC) is a professional organization that provides certification, education, and networking opportunities to medical coders. The AAPC was founded in 1988 and is the largest medical coding organization in the world.

To get certified through the AAPC, you must pass an exam that covers topics such as anatomy and physiology, ICD-10-CM/PCS coding, CPT coding, HCPCS Level II coding, and medical billing. The exam typically takes about four hours to complete.

To prepare for the exam, you can take courses offered by the AAPC or self-study using materials from their website. Additionally, there are several practice exams available from third-party vendors that can help you prepare for the real thing.

The cost of certification depends on your membership status with the AAPC. If you’re a nonmember, it costs $399 to take the exam; if you’re an AAPC member, it costs $299. There are also discounts available for veterans and students.

10. American Health Information Management Association (AHIMA)

The American Health Information Management Association (AHIMA) is the premier association of health information management (HIM) professionals. AHIMA’s mission is to empower its members and healthcare providers with the knowledge and tools to deliver quality healthcare through responsible data management. AHIMA provides education, certification, advocacy, and networking opportunities for HIM professionals around the world.

It takes approximately 6-8 weeks to become a certified member of AHIMA. To become a certified member of AHIMA, you must first meet all educational requirements set forth by the organization, which includes completing an accredited program in health information technology or related field. After meeting these requirements, applicants must pass a certification exam administered by AHIMA.

The cost of becoming an AHIMA member varies depending on the type of membership desired. The basic membership fee is $175 per year; however, there are discounts available for students and those who join through their employer or other organizations. Additionally, there may be additional fees associated with taking the certification exam and/or obtaining continuing education credits required for maintaining your membership status.

Overall, becoming a certified member of AHIMA can be beneficial for HIM professionals looking to advance their career in health information management. It provides access to resources such as educational materials, job postings, and networking opportunities that can help them stay up-to-date on industry trends and developments in the field.

11. National Association of Healthcare Revenue Integrity (NAHRI).

The National Association of Healthcare Revenue Integrity (NAHRI) is a professional organization dedicated to promoting the integrity of healthcare revenue cycle management. NAHRI provides education, resources, and networking opportunities for professionals in the field of healthcare revenue integrity.

It takes approximately two weeks to become a member of NAHRI. To get started, applicants must complete an online application form and submit it along with payment for the membership fee. The membership fee varies depending on the type of membership chosen: individual, group, or student/retiree.

Individual memberships are $150 per year and include access to NAHRI’s online library, discounts on webinars and conferences, and access to exclusive job postings. Group memberships are $500 per year and include all of the benefits of an individual membership plus discounts on multiple memberships within an organization. Student/Retiree memberships are $50 per year and include all of the benefits of an individual membership plus discounts on webinars and conferences.

In addition to membership fees, there may be additional costs associated with attending conferences or webinars hosted by NAHRI. These fees vary depending on the event but typically range from $50-$200 per person.

Do You Really Need a Claims Processor Certificate?

When it comes to the question of whether or not you need a claims processor certificate, the answer will ultimately depend on your individual circumstances. In general, a certificate can be beneficial for those who are pursuing a career in claims processing, as it can provide evidence of an individual’s knowledge and experience. It can also help employers verify that an individual has received the necessary training to handle claims-related tasks.

For those who are already working in the field of claims processing, a certificate may not be necessary, but it could still be beneficial. There are many different types of certificates available, and they can provide recognition for those who have taken steps to further their education in the field. Additionally, having a certificate may make individuals more attractive to employers when applying for jobs or promotions.

Finally, there is no single answer as to whether or not a claims processor certificate is needed. Ultimately, individuals should consider their own individual needs and circumstances when determining if obtaining certification is right for them.

Related: Claims Processor Resume Examples

FAQs About Claims Processor Certifications

1. What is a Claims Processor Certification?

Answer: A Claims Processor Certification is a certification program that validates an individual’s knowledge and skills in processing insurance claims. It is designed to ensure that claims processors are knowledgeable of the relevant laws, regulations, and procedures necessary to accurately process claims.

2. How do I become certified as a Claims Processor?

Answer: To become certified as a Claims Processor, you must complete a training program approved by the National Association of Insurance Commissioners (NAIC). The program must include both classroom instruction and hands-on experience with actual claims processing. Additionally, most states require that you pass an exam administered by the NAIC in order to receive your certification.

3. What are the benefits of becoming a Certified Claims Processor?

Answer: The primary benefit of becoming a Certified Claims Processor is increased job security and higher wages due to having specialized knowledge and credentials in this field. Additionally, obtaining this certification may provide access to higher-level positions within the insurance industry or open up opportunities for advancement into management roles.

4. How long does it take to become certified as a Claims Processor?

Answer: The length of time it takes to become certified as a Claims Processor will depend on how quickly one can complete the required coursework and examinations. Generally speaking, it can take anywhere from 6 months to 2 years depending on the program chosen and other factors such as work experience or prior education.

5. Is there any special licensing or continuing education requirements for Certified Claims Processors?

Answer: Yes, most states require Certified Claims Processors to obtain licensure from the state insurance department in order to legally practice within that state. Additionally, some states may require Certified Claims Processors to participate in ongoing continuing education courses in order to maintain their certification status.