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Health Claims Specialist: Career and Salary Facts

Research what it takes to become a health claims specialist. Learn about education requirements, job duties, median wages and job outlook to find out if this is the career for you.

What Is a Health Claims Specialist?

Health claims specialists, who may also be referred to as medical billers and coders or health information technicians, work in the field of health information management (HIM). They perform an integral role in medical or business practices that accept or provide insurance. Specifically, they collect information about medical history and patients' insurance claims, and they organize it in databases for further analyses and insurance reimbursement purposes.

Consider the information in the following table to determine if a career as a health claims specialist is right for you.

Degree Required Postsecondary certificate or associate's degree
Education Field of Study Health, computer science, math, and biology
Key Skills Analytical, interpersonal, and technical skills
Certification Required Required by most employers
Job Growth (2018-2028) 11% for all medical records and health information technicians*
Median Salary (2018) $40,350 for all medical records and health information technicians*

Source: *U.S. Bureau of Labor Statistics.

The U.S. Bureau of Labor Statistics (BLS) states that medical records and health information technicians (HITs) use a variety of electronic medical coding systems while working with electronic health records (www.bls.gov). Their primary tasks include entering patient records, treatment plans and other relevant data into medical databases. They are responsible for ensuring data accuracy and security as well as quality assurance. HITs primarily handle third party insurance reimbursement, such as Medicaid and Medicare, according to the BLS. In some cases, they may work with organ or cancer registries.

Will I Need a Degree?

The American Health Information Management Association (AHIMA) stresses the importance of attending an accredited program in order to meet professional certification standards (www.ahima.org). If you're currently in high school, the BLS indicates you may want to take biology, computer science and math classes. These courses may assist you in preparing to enroll in an associate degree or HIT postsecondary certification program.

There are four educational paths that may prepare you to enter this field; these include vocational/technical training centers, community college programs, private schools and private consultant seminar programs. You may want to look into a medical billing and coding health claims specialist program. Typical coursework covers diagnostic and procedural codes and how to process medical claims. Coursework will also include medical terminology and claims processing.

What Certifications Are There?

The BLS states you'll need professional certification, which will be periodically renewed through taking continuing education coursework. Since regulations may vary, you'll want to refer to the specific guidelines for the state in which you plan to work.

Registered Health Information Administrator

Opportunities for registered health information administrators (RHIAs) are expanding due to the growth of managed care, according to the AHIMA. These certifications may assist you with obtaining positions in insurance companies, a health maintenance organization (HMO) or a preferred provider organization (PPO).

In order to qualify for the RHIA certification exam, you need to have completed an accredited HIM bachelor's degree program. If you're from a country outside of the United States, you need to have graduated from an AHIMA-accredited program with a reciprocity agreement.

The Registered Health Information Technician Certification

If you have a bachelor's degree and are interested in becoming a manager, AHIMA indicates you may want to pursue the registered health information technician (RHIT) certification. The purpose of this credential is to demonstrate professional ability working with health information and medical records while serving the needs of providers, patients and payees. While the AHIMA states many RHITs work in hospitals, you may also find positions with home health agencies, health product vendors, insurance companies, public health agencies and pharmaceutical companies.

In order to qualify for the certification exam, you need to complete an approved HIM-based associate's degree program. This program also needs to be accredited by the Commission on Accreditation for Health Informatics and Information Management Education (CAHIIM). If you're from a country outside of the United States, you need to have graduated from a program with an AHIMA reciprocity agreement.

The Certified Coding Associate Certification

Another certification that may interest you is the certified coding associate (CCA). According to the AHIMA, this certification has received global recognition by the National Commission for Certifying Agencies and demonstrates that you have professional-level skills applicable to any type of office that handles patient health records.

The Certified Coding Specialist, Physician-Based Certification

Another certification that may lead to HIM management positions is the certified coding specialist, physician-based (CCS-P), according to the AHIMA. This certification is also intended to demonstrate professional-level coding and compliance skills.

What Salary Might I Earn?

Your salary will depend upon a variety of factors that include education, experience and certifications. The May 2018 wage report for medical records and health information technicians indicated they earned a median hourly wage of $19.4 and had a median annual salary of $40,350 per year, according to the BLS.

What Are Some Related Alternative Careers?

If you want to work in a medical office, you could also career as a medical transcriptionist. In this position, you would use specialized software to convert audio recordings of medical professionals into text formats that can be input into patients' medical histories. To gain the skills necessary for this job, you would need to complete a postsecondary certificate program. Another related option is a job as a pharmacy technician, where you would help pharmacists dispense medications and handle payments from patients and medical facilities, which can include processing insurance claims. The minimum educational requirement for this job is a high school diploma.