Top 10 Medical Claims Processor Certifications

Certifications are important for a medical claims processor in the job market because they demonstrate knowledge and expertise in the field. Certifications provide proof of qualifications and show potential employers that the applicant has met certain standards set by professional organizations. Additionally, certifications help to ensure that medical claims processors are knowledgeable about current regulations and industry best practices. This can help employers to protect their organizations from potential risks associated with incorrect processing of medical claims. Finally, certifications can give a competitive edge when applying for jobs since many employers prefer to hire those who have achieved certification.

This article reviews the top certifications for Medical Claims Processors and explains how they can help to advance a medical claims processor's career.

What are Medical Claims Processor Certifications?

Medical claims processor certification is a professional credential that provides validation and recognition of the skills and knowledge associated with medical claims processing. It is offered by the American Academy of Professional Coders (AAPC) to recognize individuals who demonstrate expertise in the field. The certification exam covers topics such as regulations, coding guidelines, medical terminology, anatomy and physiology, reimbursement methodologies, and more.

Medical claims processor certification can help individuals seeking employment in this field by providing employers with evidence of their knowledge and skills. It can also help those already working in the field by demonstrating their competency to current employers or potential clients. Additionally, it may qualify an individual for advancement opportunities or higher salaries. Finally, it can provide a sense of pride in one's accomplishments and serve as a valuable addition to any resume or job application.

Pro Tip: When considering medical claims processor certification, make sure to research the credentials and qualifications of the certifying organization. It's important to ensure that the certifying organization is reputable and has a good track record in the industry. Additionally, make sure to assess whether or not the certification will provide you with any additional skills or knowledge that can help advance your career in medical claims processing.

Related: What does a Medical Claims Processor do?

Top 10 Medical Claims Processor Certifications

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

1. Certified Professional Coder (CPC)

Certified Professional Coder (CPC) is a professional certification for medical coders. It is offered through the American Academy of Professional Coders (AAPC). The CPC certification verifies that an individual has the knowledge and skills necessary to accurately code medical services and procedures.

It typically takes between 6-12 months to prepare for the exam, depending on how much prior experience you have in coding. To get certified, you must first pass the CPC exam, which covers topics such as anatomy and physiology, medical terminology, ICD-10-CM/PCS coding systems, HCPCS Level II coding system, and reimbursement methodologies.

The cost of the CPC exam varies based on your AAPC membership status. Without a membership, it costs $399; with a membership it costs $299. Additionally, there are study materials available from AAPC that can help prepare you for the exam. These range from $50-$350 depending on what type of material you purchase.

2. Certified Medical Reimbursement Specialist (CMRS)

A Certified Medical Reimbursement Specialist (CMRS) is a professional who specializes in the medical billing and coding field. They are responsible for ensuring that medical claims are submitted accurately and on time, as well as keeping track of payments and denials from insurance companies.

It typically takes between 6 months to 1 year to become a CMRS. To obtain the certification, you must have a high school diploma or equivalent, complete an approved training program, and pass the CMRS exam administered by the American Medical Billing Association (AMBA).

The cost of becoming a CMRS varies depending on the type of training program you take. Most programs range from $500-$2,000. Additionally, there is an exam fee of $200-$300 paid directly to AMBA when registering for the exam.

3. Certified Medical Billing and Coding Specialist (CMBCS)

A Certified Medical Billing and Coding Specialist (CMBCS) is a professional who specializes in the field of medical billing and coding. They are responsible for accurately coding medical procedures, diagnoses, medications, treatments, and other services provided by healthcare providers. This ensures that insurance companies receive accurate information to process claims correctly and promptly.

It typically takes between 6-12 months to become a Certified Medical Billing and Coding Specialist (CMBCS). To get certified, individuals must complete an accredited program in medical billing and coding. These programs can be found at community colleges, vocational schools, or online. The cost of these programs vary depending on the school or institution offering them.

Once the program is completed, individuals must pass an exam administered by the American Academy of Professional Coders (AAPC) or the American Health Information Management Association (AHIMA). Upon successful completion of this exam, individuals will be awarded their certification as a CMBCS.

The cost of certification varies depending on which organization you choose to go through for your certification exam. The AAPC offers exams ranging from $199 - $399 while AHIMA offers exams ranging from $199 - $499.

4. American Academy of Professional Coders (AAPC) Certification

The American Academy of Professional Coders (AAPC) is a professional organization that provides certification for medical coders. The AAPC Certification is designed to recognize and validate the knowledge and experience of medical coding professionals. It is an industry-standard credential that demonstrates a commitment to quality, accuracy, and professionalism in the field of medical coding.

It typically takes about three months to complete the AAPC Certification process. To get certified, you must first pass a comprehensive exam that covers topics such as ICD-10-CM, CPT®, HCPCS Level II, and E/M codes. You must also have at least two years of full-time coding experience or one year of full-time coding experience plus completion of an accredited coding program. Once you have met these requirements, you can apply for the exam online and pay the associated fee.

The cost for taking the AAPC Certification exam varies depending on your membership status with AAPC. If you are not a member, it will cost $399 to take the exam; if you are a member, it will cost $299 to take the exam. In addition to this fee, there may be additional costs associated with purchasing study materials or attending review courses in order to prepare for the exam.

5. Certified Professional Medical Auditor (CPMA)

Certified Professional Medical Auditor (CPMA) is a certification program offered by the American Academy of Professional Coders (AAPC). It is designed to help healthcare professionals demonstrate their expertise in medical auditing. The CPMA credential is an important tool for those who audit medical records and claims to ensure accuracy, compliance, and efficiency.

To earn the CPMA credential, applicants must pass a 150-question exam that covers topics such as medical coding and billing, legal issues, reimbursement systems, and medical auditing principles. Applicants must also have two years of professional experience in a related field or one year of experience if they hold another AAPC certification.

The exam takes approximately three hours to complete and costs $399 for members of the AAPC or $499 for non-members. In addition to passing the exam, applicants must also agree to abide by the AAPC’s Code of Ethics and Professional Conduct.

Once certified, CPMA holders are required to recertify every two years by completing at least 20 continuing education units (CEUs). CEUs can be obtained through courses offered by the AAPC or other approved organizations. The cost of recertification is $125 for members or $175 for non-members.

6. American Health Information Management Association (AHIMA) Certification

The American Health Information Management Association (AHIMA) Certification is a professional certification that recognizes individuals who have demonstrated competency in the field of health information management. The certification is intended to provide employers with assurance that the individual has the necessary skills and knowledge to perform their job duties.

It typically takes between six months to a year to complete the AHIMA Certification process, depending on the level of training and experience one has in the field. To get certified, individuals must pass an exam that covers topics such as coding, data analysis, privacy and security, healthcare reimbursement systems, and more.

The cost of getting AHIMA Certified varies depending on the type of certification sought after. For example, the Certified Coding Associate (CCA) exam costs $299 for members of AHIMA and $399 for non-members. The Certified Coding Specialist (CCS) exam costs $399 for members and $499 for non-members. Additionally, there are fees associated with renewing certifications every two years which range from $50 to $75 for members and $100 to $125 for non-members.

In addition to passing an exam, individuals must also meet certain educational requirements before becoming certified by AHIMA. These requirements vary based on the type of certification sought after but generally include completing a minimum number of college credits or courses related to health information management or healthcare administration.

7. Certified Electronic Health Records Specialist (CEHRS)

A Certified Electronic Health Records Specialist (CEHRS) is a professional who has been trained and certified to use electronic health records (EHRs). This certification is designed to help healthcare organizations meet the requirements of the Health Insurance Portability and Accountability Act (HIPAA) for protecting patient data. CEHRS professionals are knowledgeable in the use of EHRs, including how to enter and retrieve information, maintain security, and ensure compliance with HIPAA regulations.

The certification process typically takes about 3-4 months to complete. To become certified, individuals must pass an exam administered by the National Healthcareer Association (NHA). The exam covers topics such as EHR systems, data entry, security and privacy, workflow processes, and other related topics.

To get started on the path to becoming a CEHRS professional, individuals should first review the NHA's eligibility requirements. These include having a high school diploma or equivalent; completion of an approved training program; completion of at least 30 hours of continuing education in EHRs; passing a criminal background check; and passing the NHA's CEHRS exam.

The cost of becoming a CEHRS professional varies depending on the individual's circumstances. Generally speaking, it can range from $200-$500 for registration fees plus any additional costs associated with training programs or continuing education courses.

8. Certified Healthcare Compliance Professional (CHCP)

Certified Healthcare Compliance Professional (CHCP) is a certification program offered by the Health Care Compliance Association (HCCA). The CHCP certification demonstrates an individual’s knowledge and expertise in health care compliance. It is designed for individuals who are responsible for developing, implementing, and managing health care compliance programs.

The CHCP certification program consists of two parts: a written exam and an online course. The written exam covers topics such as legal and regulatory requirements, compliance risk management, and ethical considerations in health care. The online course provides an overview of the fundamentals of health care compliance.

It typically takes about six months to complete the CHCP certification program. To get certified, you must pass both the written exam and the online course with a score of at least 75%. You must also have at least two years of experience working in health care compliance or related field.

The cost to become certified varies depending on whether you are a member or non-member of HCCA. For members, it costs $625 for the written exam and $395 for the online course. For non-members, it costs $825 for the written exam and $595 for the online course.

9. Certified Revenue Cycle Representative (CRCR)

A Certified Revenue Cycle Representative (CRCR) is a professional certification program designed to recognize individuals who possess the knowledge and skills necessary to understand, manage and optimize revenue cycle operations. The CRCR program was developed by the American Academy of Professional Coders (AAPC) in collaboration with healthcare industry experts.

The program consists of two parts: an online course and an exam. The online course covers topics such as medical coding, billing, reimbursement, collections, denials management, compliance and more. The course takes approximately 20 hours to complete and costs $299. Upon successful completion of the course, students can then take the CRCR exam which includes 150 multiple-choice questions. The exam takes three hours to complete and costs $199.

To become certified as a CRCR, candidates must pass both the online course and the exam with a score of 70% or higher. Once certified, CRCRs have access to exclusive resources such as continuing education courses, networking opportunities with other professionals in the field, job postings and more. Additionally, certified CRCRs are eligible for discounts on AAPC products and services.

10. National Alliance of Medical Auditing Specialists (NAMAS) Certification

The National Alliance of Medical Auditing Specialists (NAMAS) Certification is a professional credential that recognizes individuals who have demonstrated a high level of knowledge and expertise in medical auditing. The certification program is designed to provide healthcare professionals with the tools and resources necessary to effectively manage medical audit processes, from pre-audit planning and preparation to post-audit review.

To obtain NAMAS Certification, applicants must successfully complete an online course and pass a comprehensive exam. The course covers topics such as coding, compliance, reimbursement, fraud & abuse, HIPAA regulations, data analysis and more. It typically takes between three to six months to complete the course depending on the individual’s schedule.

Once the course is completed, applicants can register for the NAMAS Certification Exam which consists of 125 multiple-choice questions covering all aspects of medical auditing. The exam fee is $495 USD and it must be taken at a designated testing center or via remote proctoring. Applicants must achieve a score of 70% or higher in order to pass the exam and receive their certification.

In addition to passing the exam, applicants must also meet certain eligibility requirements including having two years of experience in healthcare auditing or related field; completing at least 20 hours of continuing education within the past two years; and passing a criminal background check.

Upon successful completion of all requirements, applicants will receive their official NAMAS Certificate along with an accompanying wallet card valid for three years from date of issue.

Do You Really Need a Medical Claims Processor Certificate?

The answer to this question depends on the individual and their goals. If someone is looking to enter the medical claims processing field and has no prior experience or knowledge of the industry, then a certificate could be beneficial in order to learn the basics of medical claims processing.

A certificate can provide an individual with an overview of the field, including an understanding of how medical claims are processed, what types of documents are used, and how to use healthcare software and systems. It can also provide insight into coding and reimbursement processes. A certificate can help prepare someone for entry-level positions in medical claims processing, such as data entry or billing clerk roles.

For those who have already been working in the field for some time or have some knowledge of it, a certificate may not be necessary as they may already possess enough knowledge or skills to qualify them for more advanced positions. However, obtaining a certificate may still prove beneficial depending on the individual’s goals. For example, if they want to become a medical claims processor supervisor or manager, having a certificate could make them more competitive when applying for these roles.

In conclusion, whether you need a medical claims processor certificate depends on your current level of experience and your career goals. It could be helpful if you want to gain an overview of the field or increase your competitiveness when applying for more advanced positions.

Related: Medical Claims Processor Resume Examples

FAQs About Medical Claims Processor Certifications

Q1. What is a Medical Claims Processor Certification?

A1. A Medical Claims Processor Certification is a type of certification that prepares individuals for careers in medical claims processing. It provides the necessary skills and knowledge to accurately process medical claims and ensure patients receive their benefits in a timely manner.

Q2. What are the requirements for obtaining a Medical Claims Processor Certification?

A2. The requirements for obtaining a Medical Claims Processor Certification vary by certifying organization, but typically include passing an exam and completing coursework related to medical billing, coding, and insurance policies.

Q3. How long does it take to obtain a Medical Claims Processor Certification?

A3. The amount of time it takes to obtain a Medical Claims Processor Certification depends on the certifying organization and the individual's level of experience with medical billing and coding principles. Generally, it can take anywhere from 3 months to 1 year or more to complete the necessary coursework and pass the certification exam.

Q4. How much does it cost to get certified as a Medical Claims Processor?

A4. The cost of obtaining a Medical Claims Processor Certification varies depending on the certifying organization, but usually ranges from $100 - $500 USD or more depending on additional materials such as textbooks or study guides that may be required for completion of the program.

Q5. Are there any continuing education requirements associated with maintaining my certification?

A5: Yes, many organizations require certified professionals to complete continuing education units (CEUs) in order to maintain their certification status on an annual basis in order to stay up-to-date with changes in industry standards and best practices related to medical billing and coding principles