Medical records and health information technicians organize and manage health information data.
What they do
Medical records and health information technicians, commonly referred to as health information technicians, organize and manage health information data by ensuring that it maintains its quality, accuracy, accessibility, and security in both paper files and electronic systems. They use various classification systems to code and categorize patient information for insurance reimbursement purposes, for databases and registries, and to maintain patients’ medical and treatment histories.
Health information technicians typically do the following:
- Review patients’ records for timeliness, completeness, accuracy, and appropriateness of data
- Organize and maintain data for clinical databases and registries
- Track patient outcomes for quality assessment
- Use classification software to assign clinical codes for insurance reimbursement and data analysis
- Electronically record data for collection, storage, analysis, retrieval, and reporting
- Maintain confidentiality of patients’ records
Health information technicians document patients’ health information, including their medical history, symptoms, examination and test results, treatments, and other information about healthcare services that are provided to patients. Their duties vary by employer and by the size of the facility in which they work.
Although health information technicians do not provide direct patient care, they work regularly with registered nurses and other healthcare professionals. They meet with these workers to clarify diagnoses or to get additional information to make sure that records are complete and accurate.
The increasing adaptation and use of electronic health records (EHRs) will continue to change the job responsibilities of health information technicians. Technicians will need to be familiar with, or be able to learn, EHR computer software, follow EHR security and privacy practices, and analyze electronic data to improve healthcare information.
Health information technicians can specialize in many aspects of health information. Some work as medical coders, sometimes called coding specialists, or as cancer registrars.
Medical coders typically do the following:
- Review patient information for preexisting conditions, such as diabetes, so patient data can be coded properly
- Assign appropriate diagnoses and procedure codes for patient care, population health statistics, and billing purposes
- Work as a liaison between the healthcare providers and billing offices
Cancer registrars typically do the following:
- Review patients’ records and pathology reports to verify completeness and accuracy
- Assign classification codes to represent the diagnosis and treatment of cancers and benign tumors
- Conduct annual follow-ups to track treatment, survival, and recovery
- Compile and analyze cancer patient information for research purposes
- Maintain facility, regional, and national databases of cancer patients
Medical records and health information technicians typically work in offices and may spend many hours in front of computer monitors. Some technicians may work from home.
Most health information technicians work full time. In healthcare facilities that are always open, such as hospitals, technicians may work evening or overnight shifts.
How to become a Medical Records and Health Information Technician
Health information technicians typically need a postsecondary certificate to enter the occupation, although some may need an associate degree. Certification is often required.
Postsecondary certificate and associate degree programs in health information technology typically include courses in medical terminology, anatomy and physiology, communication, health data requirements and standards, classification and coding systems, healthcare reimbursement methods, healthcare statistics, and computer systems. Applicants to health information technology programs may increase their chances of admission by taking high school courses in health, computer science, math, and biology.
A high school diploma or equivalent and previous experience in a healthcare setting are enough to qualify for some positions, but most jobs for health information technicians require postsecondary education.
The median annual wage for medical records and health information technicians was $42,630 in May 2019. The median wage is the wage at which half the workers in an occupation earned more than that amount and half earned less. The lowest 10 percent earned less than $27,820, and the highest 10 percent earned more than $71,150.
Employment of medical records and health information technicians is projected to grow 8 percent from 2019 to 2029, much faster than the average for all occupations.
An aging population will require more medical services, and health information technicians will be needed to organize and manage the older generations’ health information data. This will mean more claims for reimbursement from insurance companies.
Additional records, coupled with widespread use of electronic health records (EHRs) by all types of healthcare providers, will lead to an increased need for technicians to organize and manage the associated information in all areas of the healthcare industry.
Similar Job Titles
Coder, Health Information Clerk, Health Information Specialist, Health Information Technician (Health Information Tech), Medical Records Analyst, Medical Records Clerk, Medical Records Coordinator, Medical Records Director, Medical Records Technician (Medical Records Tech), Registered Health Information Technician (RHIT)
License Clerk, Interviewer (except Eligibility and Loan), Receptionist and Information Clerk, Medical Secretary, Office Clerk-General
The trade associations listed below represent organizations made up of people (members) who work and promote advancement in the field. Members are very interested in telling others about their work and about careers in those areas. As well, trade associations provide opportunities for organizational networking and learning more about the field’s trends and directions.
Magazines and Publications
Every time nurses or physicians treat their patients, they need to record what they have seen and done; from x-rays and examination notes, to forming diagnoses and treatment plans. Medical records technicians organize and maintain these medical documents. These technicians do not provide patient care; instead, they work behind the scenes with care providers to fill in missing information, process forms, and ensure that insurance companies receive correct records. They use coding systems to document patient information for billing and recordkeeping, and are responsible for the privacy of patient files. These technicians work at a computer for prolonged periods. Whether they’re updating clinic records or tracking a patient's outcomes, accuracy is essential, so medical records technicians must pay strict attention to detail. Some work with data to analyze health care costs and identify health data trends. Most health information technicians work full-time. In health care facilities that are open 24/7, such as hospitals or nursing care facilities, technicians may need to work evening or overnight shifts. While it’s possible to enter the field with a high school diploma and work experience in a health care setting, most employers prefer to hire candidates who've earned a certificate in this field. Passing a certification exam is often required. Medical records technicians provide a service that is critical for quality patient care.
Content retrieved from: US Bureau of Labor Statistics-OOH www.bls.gov/ooh,
CareerOneStop www.careeronestop.org, O*Net Online www.onetonline.org