Health Information Management Professionals

C H A P T E R

2Health Information

Management Professionals

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35

Chapter Outline

Key Terms

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cancer registrarcase managerclaims examinercoding and reimbursement

specialistcoding specialistconsultantethicshealth information manager

health insurance specialisthealth services managerListservmedical assistantmedical office administratormedical office managermedical staff coordinatormedical transcriptionistprivacy officer

professional practice experienceprofessional practice supervisorquality managerreciprocityrisk managertumor registrarutilization managervendor salesperson

� Key Terms

� Objectives

� Introduction

� Careers

� Professional Practice Experience

� Join Your Professional Association

� Internet Links

� Summary

� Study Checklist

� Chapter Review

ObjectivesAt the end of this chapter, the student shouldbe able to:• Differentiate among health information management

career opportunities

• List training and credentialing processes for health information careers

36 • Chapter 2

• Identify professional organizations dedicated to healthcare professionals

• Name the benefits of completing an academic profes-sional practice experience

• Explain student responsibilities during the profes-sional practice experience

INTRODUCTION

This chapter will focus on a variety of career opportu-nities in health care and health information manage-ment, the role of the professional practice experience(or externship), the importance of joining professionalorganizations, the interpretation of professional codesof ethics, the impact of networking with other profes-sionals, and the development of opportunities forprofessional advancement.

CAREERS

Health information management combines a profes-sion in health care with information technology. Em-ployment opportunities are available in differenttypes of health care settings as well as in a variety ofpositions within those settings. Depending on the aca-demic program in which you are enrolled and yourfuture health care professional aspirations, one ormore of the career opportunities discussed below willappeal to you. Each career discussed contains anoverview of job requirements as well as informationabout training, credentialing, and current and futureemployment opportunities.

Cancer RegistrarCancer registrars (or tumor registrars) collect cancerdata from a variety of sources and report cancer sta-tistics to government and health care agencies (e.g.,state cancer registries). The primary responsibility ofthe cancer registrar is to ensure the timely, accurate,and complete collection and maintenance of cancerdata. The cancer registrar enters information into acomputer database, either manually or through data-base linkages and computer interfaces. They workclosely with physicians, administrators, researchers,and health care planners to provide cancer programdevelopment support, ensure compliance with

reporting standards, and serve as a valuable resourcefor cancer information.

Training

College-based cancer registry management programstypically include coursework in medical terminology,anatomy and physiology, health information manage-ment, computer information systems, health data col-lection, epidemiology, cancer registry management,and cancer case abstracting, coding, and staging. Inaddition to formal college courses, students are re-quired to complete a professional practice experiencethat totals 160 unpaid hours. Once formal educationhas been achieved, continuing education is availablein a variety of formats (e.g., daylong workshops, in-tensive two-week training programs, and Web-basedtraining modules).

Credentials

Eligibility requirements for the Certified Tumor Reg-istrar (CTR) credential include a combination of expe-rience in the cancer registry profession and/or formaleducation. The National Cancer Registrars Associa-tion (NCRA) administers the CTR examination to“foster the professional integrity of registrars throughcertification and recognition.” Once certified, theNCRA requires CTRs to pay an annual continuing ed-ucation maintenance fee and to submit proof of 20continuing education hours every two years (so thatindividuals remain up-to-date in the fields of oncol-ogy and cancer registry management).

Employment Opportunities

Job opportunities for cancer registrars exist in a vari-ety of settings, including hospital-based, state, central,or regional cancer registries; consulting firms forwhich travel is a requirement; and private and government agencies (e.g., American College of

Surgeons, Centers for Disease Control). The NationalProgram of Cancer Registries (NPCR), a product ofthe 1992 Cancer Registries Amendment Act, autho-rizes the Centers for Disease Control and Prevention(CDC—a federal government agency responsible forprotecting the health and safety of people) to providefunds to states and territories to improve existing can-cer registries; to plan and implement registries wherethey do not exist; to develop model legislation andregulations for states to enhance the viability of reg-istry operations; to set standards for data complete-ness, timeliness, and quality; to provide training forregistry personnel; and to help establish a computer-ized reporting and data-processing system. As a re-sult of the program, employment opportunities forcancer registrars have grown, and the job outlook re-mains excellent.

Coding and Reimbursement SpecialistA coding and reimbursement specialist (or codingspecialist) acquires a working knowledge of CPT(Current Procedural Terminology) and ICD-9-CM (In-ternational Classification of Diseases, Ninth Revision,Clinical Modification) coding principles, governmen-tal regulations, and third-party payer (e.g., insurancecompany) requirements to ensure that all diagnoses(conditions), services (e.g., office visit), and proce-dures (e.g., surgery, X-ray) documented in patientrecords are coded accurately for reimbursement, re-search, and statistical purposes. Coding is the assign-ment of numbers to diagnoses, services, andprocedures, based on patient record documentation.Excellent interpersonal skills are also required of cod-ing specialists, who must communicate withproviders about documentation and compliance is-sues related to the appropriate assignment of diagno-sis and procedure codes.

Training

A variety of training methods are available to thoseinterested in a coding and reimbursement specialistcareer. College-based programs include courseworkin medical terminology, anatomy and physiology,health information management, pathophysiology,pharmacology, ICD-9-CM and CPT coding, and reim-bursement procedures. In addition, most academicprograms require students to complete an unpaidprofessional practice experience (e.g., 240 hours).

Professional associations (e.g., American Health In-formation Management Association, AHIMA) offernoncredit-based coding training, usually as distancelearning (e.g., Internet-based), and some health carefacilities develop internal programs to retrain healthprofessionals (e.g., nurses) who are interested in a ca-reer change.

Credentials

Two professional associations, AHIMA and the Amer-ican Academy of Professional Coders (AAPC), offercertification in coding. Credentials available fromAHIMA include the Certified Coding Associate(CCA), Certified Coding Specialist (CCS) and Certi-fied Coding Specialist–Physician-based (CCS-P). TheAAPC offers the Certified Professional Coder (CPC)and Certified Professional Coder–Hospital (CPC-H),as well as Apprentice status for each (CPC-Appren-tice, or CPC-A, and CPC-H-Apprentice, or CPC-H-A).The type of health care setting in which you seek em-ployment will direct you to the proper credential. In-patient and/or outpatient coders obtain CCScertification, and physician office coders choose theCCS-P and/or CPC credential. Outpatient coders alsohave the option of selecting the CPC-H credential.Those who have not met requirements for field expe-rience as a coder can seek apprentice-level certifica-tion as a CCA, CPC-A, or CPC-H-A.

Once certified, both professional associations re-quire maintenance of the credential through continu-ing education (CE) recertification. AHIMA requires 10CE hours for one credential and a total of 20 if the in-dividual is certified as both a CCS and CCS-P. TheAAPC requires 18 CE hours to maintain one creden-tial, and 24 CE hours to maintain both the CPC andCPC-H credentials.


Coding and Reimbursement Specialists can obtainemployment in a variety of settings, including clinics,consulting firms, government agencies, hospitals, in-surance companies, nursing facilities, home healthagencies, hospices, and physician offices. Coding spe-cialists also have the opportunity to work at home for employers who partner with an Internet-based application service provider (ASP). For example,eWebCoding.com is a third-party entity that managesand distributes software-based services and solutionsto customers across a wide area network (WAN—

Health Information Management Professionals • 37

computers that are far apart and are connected bytelephone lines) from a central data center.

Health Information ManagersEach time patients receive health care, a record is gen-erated to document the patient’s current symptoms,medical history, results of examination, treatmentsrendered along with outcomes, ancillary report re-sults (e.g., laboratory), diagnoses, and plans for treat-ment. This patient data is organized, analyzed, andmaintained by health information managers to ensurethe delivery of quality health care. According to theAHIMA, health information managers are consid-ered experts in managing patient health informationand medical records, administering computer infor-mation systems, and coding diagnoses and proce-dures for health care services provided to patients.

Training

A health information technician (HIT) earns an asso-ciate degree from a community, junior, or technicalcollege; and a health information administrator(HIA) earns a bachelor’s degree from college or uni-versity. To be eligible to take the national certificationexam offered by AHIMA, a person must graduatefrom a program accredited by the Commission onAccreditation of Allied Health Education Programs(CAAHEP) in cooperation with AHIMA’s Council onAccreditation. In addition to general education,coursework includes medical terminology, anatomyand physiology, legal aspects of health information,coding and abstraction of data, statistics, databasemanagement, quality improvement methods, andcomputer training. Students are also required to com-plete professional practices in the health informationmanagement departments of a variety of health caresettings (e.g., acute, ambulatory, long-term, and men-tal health care).

Credentials

Most employers prefer to hire Registered Health In-formation Technicians (RHIT) or Registered HealthInformation Administrators (RHIA), who must pass a written credentialing examination offered byAHIMA. AHIMA requires credentialed individuals topay an annual continuing education maintenance feeand to submit proof of continuing education hoursevery two years to ensure that individuals remain up-to-date in the field of health information manage-ment. RHITs are required to obtain 20 CE hours in a

two-year period, and RHIAs are required to obtain 30CE hours in a two-year period.


Job titles for RHITs include health data analyst, insur-ance claims analyst, records technician specialist, clin-ical coding specialist, physician practice manager, andpatient information coordinator. RHIA job titles in-clude department director, system manager, dataquality manager, information security officer, educa-tor, and consultant. According to the Bureau of LaborStatistics, employment for health information man-agement professions is expected to grow much fasterthan the average for all occupations through 2010,due to rapid growth in the number of medical tests,treatments, and procedures which will be increasinglyscrutinized by third-party payers, regulators, courts,and consumers.

Health Insurance SpecialistA health insurance specialist (or claims examiner)reviews health-related claims to determine whetherthe costs are reasonable and medically necessary,based on the patient’s diagnosis. This process in-volves verification of the claim against third-partypayer guidelines to authorize appropriate payment orrefer the claim to an investigator for a more thoroughreview. A health information manager can also per-form medical billing, coding, record keeping, andother medical office administrative duties.

Training

Training and entry-level requirements vary widely forhealth insurance specialists; most third-party payersprefer to hire college or vocational school graduatesand provide additional training on the job.

Credentials

While most health insurance specialists become certi-fied as a CCS or CCS-P (through the AHIMA) or aCPC or CPC-H (through the AAPC), three other orga-nizations offer specialty certifications.

The Alliance of Claims Assistance Professionals(ACAP) is a not-for-profit corporation managed andoperated by its members. It offers certification exami-nations for the Electronic Claims Professional (ECP—converts patient billing information into electronicallyreadable formats) and the Claims Assistance Profes-sional (CAP—assists consumers in obtaining full ben-efits from health care coverage).

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The American Medical Billing Association (AMBA)was created to network, share information and ideas,support one another, and publicly market profes-sional services as a group. AMBA is targeted towardproviding assistance for small and home-based pro-fessional medical billers with similar needs, interests,and goals.

The International Claim Association (ICA) pro-vides a program of education for its member life andhealth insurance companies, reinsurers, managedcare companies, third-party administrators (TPAs),and Blue Cross and Blue Shield organizations world-wide. The ICA offers Associate, Life and HealthClaims (ALHC) and the Fellow, Life and HealthClaims (FLHC) examinations to claims examiners inthe life and health insurance industries. According tothe ICA, the ALHC and FLHC designations areawarded only upon successful completion of all re-quired courses in both the introductory and ICAcourse segments. The ALHC program contains sixcourses designed to provide students with a thoroughbackground in the administration of life and healthinsurance claims. The FLHC Program provides ad-vanced claims education by requiring four additionalcourses.

The Medical Association of Billers is an insuranceclaims organization that offers Certified MedicalBilling Specialist (CMBS) certification. CMBSs mustcomplete 12 continuing education units (CEUs) eachyear to remain current.


Health insurance specialists are employed by insur-ance companies, third-party administrators, and man-aged care companies. According to the Bureau ofLabor Statistics, employment is expected to growabout as fast as the average for all occupationsthrough 2010. Opportunities will be best in the areasof property and casualty insurance, and health insur-ance, with many job openings resulting from the needto replace workers who transfer to other occupationsor leave the labor force.

Health Services ManagerHealth services managers are individuals who plan,direct, coordinate, and supervise the delivery ofhealth care. They include specialists who direct clini-cal departments or services and generalists who man-age an entire facility or system. Because of health care restructuring and refinancing, health services

managers often deal with evolving integrated healthcare delivery systems (an arrangement betweenhealth care providers to offer comprehensive servicesas a single health care delivery system), technologicalinnovations, complex regulations, and an increasedfocus on preventive care. They are also required to im-prove health care efficiency and quality.

Training

According to the Bureau of Labor Statistics, most gen-eral health services managers earn a master’s degreein a related health services administration field, whilea bachelor’s degree is adequate for most entry-levelpositions in smaller facilities and at the departmentallevel within health care organizations. Clinical de-partment heads usually require a degree in the appro-priate field along with work experience (e.g., nursingdepartment).

Credentials

Health services managers who become nursing homeadministrators are required by all states and the Dis-trict of Columbia to have a bachelor’s degree, pass alicensing examination, complete a state-approvedtraining program, and pursue continuing education.The American College of Health Care Administrators(ACHCA) offers the Certified Nursing Home Admin-istrator (CNHA) credential, which is endorsed by theNational Association of Boards of Examiners for LongTerm Care Administrators (NAB) as an option forstate licensure reciprocity (credential is recognized byanother entity). Many states currently recognize theACHCA’s CNHA program, and additional states arein the process of officially recognizing the CNHA pro-gram or are favorably considering the program as anoption for reciprocity.

NOTE: A license is not required in other areas ofmedical and health services management.


According to the Bureau of Labor Statistics, employ-ment of medical and health services managers is ex-pected to grow faster than the average for alloccupations through 2010 as the health services in-dustry continues to expand and diversify. Opportuni-ties for managers will be closely related to growth inthe industry in which they are employed. Opportuni-ties will be especially good in home health care, long-term care, and nontraditional health organizations,


such as managed care operations and consultingfirms. Managers with work experience in the healthcare field and who have strong business and manage-ment skills should have the best opportunities.

Hospitals will continue to employ the most man-agers, although the number of jobs will grow slowlycompared with other areas. Employment will growthe fastest in residential care facilities and practition-ers’ offices and clinics because services previouslyprovided in hospitals will continue to shift to thesesectors.

Medical AssistantMedical assistants perform routine administrativeand clinical tasks to keep the offices and clinics ofphysicians, podiatrists, chiropractors, and op-tometrists running smoothly. (They should not beconfused with physician assistants who examine, di-agnose, and treat patients under the direct supervi-sion of a physician.) Medical assistants who performmainly administrative duties answer telephones,greet patients, update and file patient medicalrecords, complete insurance claims, process corre-spondence, schedule appointments, arrange for hos-pital admission and laboratory services, and managethe office’s billing and bookkeeping.

The clinical duties of a medical assistant vary ac-cording to state law and include taking medical histo-ries and recording vital signs, explaining treatmentprocedures to patients, preparing patients for exami-nation, and assisting the physician during the exami-nation. Medical assistants also collect and preparelaboratory specimens or perform basic laboratorytests on the premises, dispose of contaminated sup-plies, and sterilize medical instruments. They instructpatients about medication and special diets, prepareand administer medications as directed by a physi-cian (if allowed under state law), authorize drug re-fills as directed, telephone or fax prescriptions to apharmacy, draw blood, prepare patients for X-rays,take electrocardiograms, remove sutures, and changedressings.

Training

A medical assistant earns an associate degree from acommunity, junior, or technical college or a vocationalschool. In addition to general education, students takeanatomy, physiology, medical terminology, keyboard-ing, medical transcription, administrative and clinical

medical assisting, accounting, and insurance process-ing. Students learn laboratory techniques, clinical anddiagnostic procedures, pharmaceutical principles,medication administration, and first aid. They studyoffice practices, patient relations, medical law, andethics. Most programs require students to completeprofessional practice in physicians’ offices or otherhealth care facilities.

Credentials

Medical assistants become credentialed as a CertifiedMedical Assistant (CMA) through the American As-sociation of Medical Assistants (AAMA) or a Regis-tered Medical Assistant (RMA) through the AmericanMedical Technologists (AMT). The credentials are notmandatory in most states, and the federal govern-ment does not require a medical assistant to be cre-dentialed. To be eligible to take the CMA exam,students must graduate from a medical assisting pro-gram accredited by either the Commission on Accred-itation of Allied Health Education Programs(CAAHEP) or the Accrediting Bureau of Health Edu-cation Schools (ABHES). (Be sure to check the accred-itation status of your academic program.) Studentsenrolled in programs not accredited by CAAHEP orABHES, but whose college is accredited by an organi-zation approved by the United States Department ofEducation, are eligible for RMA certification.


According to the Bureau of Labor Statistics, employ-ment for medical assistants is expected to grow muchfaster than the average for all occupations through2010 as the health services industry expands becauseof technological advances in medicine and a growingolder population. Employment growth will also resultfrom an increase in the number of group practices,clinics, and other health care facilities that need per-sonnel such as the medical assistant who can handleboth administrative and clinical duties.

Medical TranscriptionistMedical transcriptionists transcribe prerecorded dic-tation, creating medical reports (e.g., history, physical,discharge summary), correspondence, and other ad-ministrative material (e.g., committee minutes). Theyuse a special headset to listen to dictation and a footpedal to pause dictation as they key text into a per-sonal computer (editing grammar as necessary).

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Before becoming a permanent part of the patient’srecord, the transcribed documents are forwarded tothe dictator for review and signature, or correction.

Many medical transcriptionists work at home, andthe Internet has transformed the procedure of receiv-ing dictation and returning transcribed reports toclients for approval. (In the past, cassette tapes weredelivered to medical transcriptionists.) An emergingtrend is the implementation of speech recognitiontechnology, which electronically translates sound intotext and creates drafts of reports. Reports are then for-matted; edited for mistakes in translation, punctua-tion, or grammar; and checked for consistency andpossible medical errors. Transcriptionists working inspecialized areas with more standard terminology,such as radiology or pathology, are more likely to en-counter speech recognition technology.

Training

Employers prefer to hire medical transcriptionistswho have completed postsecondary training in med-ical transcription offered by many vocational schools,community colleges, and distance-learning programs.In addition to medical transcription practice course-work, students take anatomy, physiology, medical terminology, disease processes, pharmacology,medicolegal issues, keyboarding, and English gram-mar and punctuation. Most academic programs alsorequire students to complete a professional practice inthe medical transcription department of a health carefacility.

Credentials

The American Association for Medical Transcription(AAMT) offers the Certified Medical Transcriptionist(CMT) credential to those who earn passing scores onwritten and practical examinations. The AAMT re-quires CMTs to become recertified every three yearsby earning continuing education credits.


According to the Bureau of Labor Statistics, employ-ment of medical transcriptionists is projected to growfaster than the average for all occupations through2010 due to older patients receiving greater numbersof medical tests, treatments, and procedures that re-quire documentation. In addition, demand for tran-scription services will be influenced by the need forelectronic documentation that can be easily shared

among providers, third-party payers, regulators, andconsumers. Advancements in speech recognitiontechnology will not adversely impact job opportuni-ties for medical transcriptionists because of the needto review and edit draft reports for accuracy.

Other Employment Opportunities inHealth Information ManagementA consultant practices a profession. Consultant is ageneral term that can be applied to any number of in-dividuals with a wide variety of educational back-grounds, knowledge, and skills. Health informationmanagement consultants specialize in coding, long-term care, information security, ambulatory care, andso on. They provide assistance (e.g., backlog codingprojects), advice (e.g., coding validation studies to de-termine staff training needs), and information (e.g.,credentialed person who consults for a long term carefacility).

A medical office manager (or medical office administrator) coordinates the communication, con-tract, data, financial, human resource, health informa-tion, insurance, marketing, and risk managementoperations of a provider’s office. (Refer to Table 2-1for detailed tasks associated with each area of officemanagement.)

A medical office manager usually earns at least acertificate or an associate degree from a community,junior, or technical college. Academic programs aredesigned to provide students with practical and man-agerial skills required by medical practices. Some areassociated with medical assistant programs, requiringstudents to study office practices, patient relations,medical law, and ethics. Most programs require stu-dents to complete professional practice in physicians’offices or other health care facilities. The ProfessionalAssociation of Health Care Office Managers sponsorsMedical Office Manager (MOM) certification, whichis available to members who meet eligibility criteria.

Medical staff coordinators usually report directlyto the health care facility’s administrator, and they areresponsible for managing the medical staff office (e.g.,attending medical staff meetings) and complyingwith medical staff bylaws (e.g., physician credential-ing and recredentialing process) and accreditationand regulatory agencies. Educational opportunitiesinclude enrollment in the National Association forMedical Staff Services (NAMSS) Independent StudyProgram or at a community, junior, or technical college. The NAMSS sponsors two credentials: the


Certified Medical Staff Coordinator (CMSC) and theCertified Provider Credentialing Specialist (CPCS).Examination eligibility requirements are availablefrom the NAMSS.

According to AHIMA, a privacy officer overseesall ongoing activities related to the development, im-plementation, maintenance of, and adherence to theorganization’s policies and procedures covering theprivacy of, and access to, patient health informationin compliance with federal and state laws and thehealth care organization’s information privacy prac-tices. Privacy officers have an appropriate educationalbackground and work experience in legislation (laws)related to information privacy, access to records, andrelease of information. They are also knowledgeableabout security technologies and apply HIM principles

to project and change management. Education as ahealth information technician or health informationadministrator plus appropriate experience in healthcare legislation will qualify you for a privacy officerposition in a health care facility. In 2002, AHIMA in-troduced the Certified in Healthcare Privacy (CHP)credential, which is intended to represent advancedknowledge and competencies in health informationprivacy management. AHIMA and the Healthcare In-formation and Management Systems Society (HIMSS)entered into a collaborative agreement with AHIMAoffering the CHP credential and HIMSS offering theCertified in Healthcare Security (CHS) credential.AHIMA and HIMSS will jointly offer a combined cre-dential entitled Certified in Healthcare Privacy andSecurity (CHPS).

42 • Chapter 2

Table 2-1 Medical Office Management Responsibilities

Management Area Associated Responsibilities

Communication Conflict resolution (e.g., patients, office staff)Public speaking (e.g., staff training)Telephone (e.g., patients, sales representatives)Written communication (e.g., policies, procedures)

Contracts Analysis and interpretationDevelopment and negotiation

Data Computer applications (e.g., database, spreadsheet, word processing)Interpretation of computer data printoutsVendor systems (e.g., medical office management software)Software analysis and training

Financial Accounts payable and receivableBudget—personnel and supplies/expensesInventory controlPayrollPurchasing

Human Resources BenefitsInterviewing, hiring, training, counseling, and terminating personnelJob descriptionsLegislationPerformance evaluation

Health Information Legislation (e.g., retention laws)Patient record management (e.g., storage, retrieval)

Insurance Claims processingCodingThird-party payers

Marketing Community referralsMedical practice products

Risk ConfidentialityEthicsMedical malpractice

A quality manager coordinates a health care facil-ity’s quality improvement program to ensure qualitypatient care, improve patient outcomes, confirm accreditation/regulatory compliance, and prepare forsurveys. Quality managers have usually obtained ap-propriate work experience in a related field (e.g., di-rector of health information) after first pursuingformal education (e.g., bachelor’s degree in health in-formation management). The National Association forHealthcare Quality (NAHQ) sponsors the CertifiedProfessional in Healthcare Quality (CPHQ) credential.Eligibility requirements are available from the NAHQ.

A risk manager is responsible for gathering infor-mation and recommending settlements concerningprofessional and general liability incidents, claims,and lawsuits. They initially investigate and analyzeactual and potential risks to the health care facility aswell as review and investigate incident reports for thepurpose of recommending appropriate corrective ac-tion. Educational requirements for a risk manager in-clude a bachelor’s degree and work experience in oneor more of the following areas: patient care, publicpolicy, health care administration, business adminis-tration, legal support, or insurance/claims investiga-tion and settlement. The Global Risk ManagementInstitute (GRMI), a subsidiary of the Risk & InsuranceManagement Society, Inc. (RIMS), sponsors the Cer-tificate in Risk Management (CRM) and the Fellow inRisk Management (FRM) credentials. The Center forthe Advancement of Risk Management Education(CARME), a division of the American Institute forChartered Property Casualty Underwriters and theInsurance Institute of America (AICPCU/IIA), offersthe Associate in Risk Management (ARM) programthat allows an individual to list the ARM abbreviationafter their name.

A utilization manager (or case manager) is re-sponsible for coordinating patient care to ensure theappropriate utilization of resources, delivery of healthcare services, and timely discharge or transfer. Uti-lization managers usually have a bachelor’s degree(e.g., nursing, social work), professional licensure(e.g., RN), and clinical practice experience. Becausesome utilization managers must have extensiveknowledge of coding and reimbursement systems,health information managers are also employed inthese positions. The Certified Case Manager (CCM)credential is sponsored by the Commission for CaseManager Certification (CCMC) and endorsed by theCase Management Society of America, CMSA, which

is a not-for-profit organization that provides casemanagement networking and continuing educationopportunities. CCMs are eligible to join the Academyof Certified Case Managers (ACCM), which focuseson providing continuing education services and pro-moting expert practices in case management.

Vendor salespersons manage a company’s salesfor a given territory, provide information about avail-able consulting services, and demonstrate products topotential customers. Professional advancement op-portunities usually exist within the organization withpromotion to marketing manager, customer manager,or corporate account manager. Computer vendor po-sitions usually require a bachelor’s degree level of ed-ucation or higher and prior experience in healthinformation management sales. Personal characteris-tics include the ability to be a team player and to man-age critical issues.

Health information managers obtain employmentin a variety of settings other than health care, includ-ing data warehousing companies (e.g., research datamanagement, clinical trials management). Becausebusinesses enter information into different databases(e.g., financial, case management), a data warehousecombines the data in a consistent way so that in-quiries can be made across the entire data set. An in-dividual with a health information managementbackground is a logical person for employment by thewarehouse company. Other employment settings forhealth information managers include governmentagencies (e.g., state departments of health, peer re-view organizations), the pharmaceutical industry(e.g., data collection/studies for new drug approval),and research support (e.g., Centers for Disease Control).

Exercise 2–1 Careers

Instructions: Research career information at the Bu-reau of Labor Statistics (BLS) Web site.

1. Open your Internet browser (e.g., Internet Ex-plorer, Netscape Navigator, and so on).

2. Enter http://www.bls.gov to access the BLS Website.

3. Locate the section entitled Occupations. Click onOCCUPATIONAL OUTLOOK HANDBOOK.

4. Use the index to search for information regardingyour future career (e.g., Health Information Tech-nician, Medical Assistant, and so on).


5. Once you locate your career, click on its title.

6. Prepare a one-page, double-spaced summary of ca-reer information, including a description of thework, working conditions, employment, training,other qualifications and advancement, job outlook,and earnings. Include facts listed on the Web site.

PROFESSIONAL PRACTICEEXPERIENCE

The professional practice experience (externship) ben-efits both the student and the facility that accepts thestudent for placement. Students receive on-the-job ex-perience prior to graduation, which assists them inobtaining permanent employment, and facilities havethe opportunity to participate in and improve the for-mal education process. Quite often, students whocomplete professional practices are later employed bythe facility at which they completed the experience.Academic programs (e.g., health information man-agement, medical assistant) are required to place stu-dents in professional practice experiences to complywith accreditation requirements; other programs thatalso require such experiences provide students with avalue-added education. (Even if your academic pro-gram doesn’t require you to complete a professionalpractice experience, you can arrange to volunteer in ahealth care facility so that you can benefit from actualwork experience.)

Preparing for the Professional PracticeTo provide the maximum benefit to students, profes-sional practices are non-paid work experiences thatare arranged by the academic program faculty. Stu-dents are usually told about the professional practicerequirement in their first semester of study, and in-formation about possible practice sites may be ob-tained at that time or during a later semester. Oncethe practice sites are identified, communicate themto the academic program faculty to determinewhether student placement is possible. The programdirector sends a letter (Figure 2-1) to the site, whichintroduces the student and details academic coursesthat will have been completed by the start of the pro-fessional practice experience. Attached to the letterare the standard articulation agreement (Figure 2-2),which must be signed by an administrative repre-sentative of the site, and a student evaluation instru-

ment (Figure 2-3) that delineates tasks to be accom-plished by the student.

Creating a Professional Résumé andPreparing for an InterviewStudents are often required to submit a professionalrésumé to the professional practice supervisor (theperson to whom the student reports) and to schedulean interview prior to being accepted for placement.While this can be an intimidating process, it is excel-lent experience for the interview process you will un-dergo prior to obtaining permanent employment. Besure to research the résumé writing and interviewtechnique services available from your college’s ca-reer services office. This office will review your ré-sumé and provide you with interview tips. Someoffices even videotape mock interviews for students.

Student Responsibilities During theProfessional PracticeThe professional practice is on-the-job training eventhough it is non-paid, and students should expect toprovide proof of immunizations (available from yourphysician), undergo a pre-employment physical examination, and participate in facility-wide and department-specific orientations. In addition, becauseof the focus on privacy and security of patient infor-mation, the facility will require you to sign a non-disclosure agreement (Figure 2-4), which is kept on fileat your college and by the professional practice site.

NOTE: Breach of patient confidentiality can resultin termination from the professional practice site, fail-ure of the professional practice course, and even pos-sible suspension and/or expulsion from youracademic program. Be sure to check your academicprogram’s requirements regarding this issue.

During the professional practice experience, youare expected to report to work according to the sched-ule established by your supervisor. If you cannot at-tend on a particular day or if you will arrive late, besure to call in. (You will be required to make up anylost time.) Because this is a simulated job experience,you are also expected to be well groomed and to dressprofessionally. In addition, it is very important thatyou act interested in all aspects of the experience, de-velop good working relationships with coworkers,and react appropriately to criticism and direction. Ifany concerns arise during the experience, be sure to

44 • Chapter 2

discuss them with your professional practice supervi-sor and/or instructor.

Professional Code of Ethics

Ethics are judgments about what is right and wrong,and each professional association has a code of ethicsthat is to be followed by its membership. Even if youare not an active member in your professional as-sociation, you are expected to comply with the

established ethics. (Professional codes of ethics can befound in Appendix I and at your professional associ-ation’s Web site.)

Exercise 2–2 Professional Practice Experience

1. Identify five health care facilities and/or officesthat could serve as professional practice sites. Usethe telephone book or search the Internet to locatefacilities and/or office in your area.


,

,

Figure 2-1 Sample Professional Practice Letter (Permission to reprint granted by Alfred State College.)

46 • Chapter 2

Figure 2-2 Sample Professional Practice Articulation Agreement (partial) (Permission to reprint granted byAlfred State College.)


Figure 2-3 Sample Student Evaluation Instrument (Permission to reprint granted by Alfred State College.)

2. Contact each facility and/or office, and talk withthe switchboard operator or office receptionist toidentify the name and phone number of the de-partment manager or other professional to whomyou would report during the professional practice.Be sure to explain that you are a student in an aca-demic program (identify the program) and thatyou are gathering preliminary information for an assignment. It is possible that you will be

transferred to the department in which you wouldcomplete the professional practice.Remember! You are not authorized to discuss the

specifics of the professional practice placement. Thatis the responsibility of your college’s professionalpractice coordinator, who has performed this taskhundreds of times and is in a position to provide spe-cific information upon request. When students initiateconversations about professional practices, it can be

48 • Chapter 2

Figure 2-4 Sample Non-Disclosure Agreement (Permission to reprint granted by Bibbero Systems, Inc.,Petaluma, CA (800) 242-2376. www.bibbero.com.)

perceived as inappropriate and unauthorized. Thiscan result in a site refusing to accept a student forplacement.

NOTE: Because this assignment provides an excel-lent way to initiate contact with working profession-als who can eventually help you obtain employment,be courteous, patient, and polite.3. Generate a list of potential professional practice

sites including the name of the facility, mailing ad-dress, contact person in the HIM department, andthe contact person’s telephone number (includingarea code).

4. Submit the information to your instructor (or otherindividual identified by your instructor) using theformat in Table 2-2.

JOIN YOUR PROFESSIONALASSOCIATION

Students are often able to join their professional asso-ciation (Table 2-3) for a reduced membership fee andreceive most of the same benefits as active members

(who pay much more!). Benefits of joining your pro-fessional association include:

• Receiving publications (e.g., professional journals)• Web site access for members only• Networking with members (professional practice

and job placement)• Reduced certification exam fees• Eligibility for scholarships and grants

Attending professional conferences and meetingsis one way to network with professionals. Another isto join a Listserv, which is an Internet-based or emaildiscussion forum that covers a variety of topics andissues (Table 2-4).

Exercise 2–3 Join Your Professional Association

1. Review Table 2-3 to identify the professional asso-ciation for your health-related careers.

2. Contact your professional association and re-quest a student membership application. (Most ap-plication forms are available at the professional


Table 2-2 Professional Practice Placement Form

Student Name: _______________________________________________________________________________________________

Mailing Address: _____________________________________________________________________________________________

Telephone Number (Daytime): _________________________________________________________________________________

Telephone Number (Evening): _________________________________________________________________________________

Email Address: _______________________________________________________________________________________________

Name of Academic Program: __________________________________________________________________________________

Number/Name of Professional Practice Course: __________________________________________________________________

Name of Facility or Office Mailing Address Contact Person Telephone Number

(1)

(2)

(3)

(4)

(5)

association’s Web site. Refer to the Internet Linkssection of this chapter.)

3. Complete the application form and, if required, ob-tain your program director’s signature.

4. Submit the application to the professional associa-tion with payment.NOTE: Student membership fees are usually less

than for active members, but you receive many of thesame benefits.

INTERNET LINKS

Academy of CertifiedCase Managers http://www.academyccm.org

Alliance of ClaimsAssistance Professionals(ACAP) http://www.claims.org

American Associationof Medical Assistants(AAMA) http://www.aama-ntl.org

American Associationof Medical Transcription(AAMT) http://www.aamt.org

American Academyof Professional Coders(AAPC) http://www.aapc.com

American College ofHealth Care Administrators(ACHCA) http://www.achca.org

American HealthInformation ManagementAssociation(AHIMA) http://www.ahima.org

American Institute forChartered Property CasualtyUnderwriters (AICPCU)and Insurance Instituteof America (IIA) http://www.aicpcu.org

American MedicalBilling Association(AMBA) http://www.ambanet.net/amba.htm

American MedicalTechnologists(AMT) http://www.amt1.com

Bureau of LaborStatistics http://www.bls.gov

Case ManagementSociety of America http://www.cmsa.org

Commission for CaseManager Certification(CCMC) http://www.ccmcertification.org

eWebCoding http://www.ewebcoding.com

50 • Chapter 2

Table 2-3 Careers and Related Professional Associations

Career Professional Associations

Cancer Registrar National Cancer Registrars Association (NCRA)Coding Specialist American Academy of Professional Coders (AAPC)

American Health Information Association (AHIMA)Health Information Manager American Health Information Association (AHIMA)Health Insurance Specialist Alliance of Claims Assistance Professionals (ACAP)

International Claim Association (ICA)Medical Association of Billers (MAB)

Health Services Manager American College of Health Care Administrators (ACHCA)Medical Assistant American Association of Medical Assistants (AAMA)

American Medical Technologists (AMT)Medical Office Manager Professional Association of Health Care Office Managers (PAHCOM)Medical Staff Coordinator National Association for Medical Staff Services (NAMSS)Medical Transcriptionist American Association for Medical Transcription (AAMT)Quality Manager National Association for Healthcare Quality (NAHQ)Risk Manager Center for the Advancement of Risk Management Education (CARME)

Global Risk Management Institute (GRMI)Utilization Manager Case Management Society of America (CMSA)

Health InformationTechnology YellowPages http://www.health-infosys-dir.com

InternationalClaim Association(ICA) http://www.claim.org

National Associationof Medical StaffServices http://www.namss.org

National Cancer RegistrarsAssociation (NCRA) http://www.ncra-usa.org

Professional Associationof Health Care OfficeManagement(PAHCOM) http://www.pahcom.com

Risk and InsuranceManagementSociety, Inc. http://www.rims.org


Table 2-4 Internet-Based Bulletin Boards and Discussion Forums (Listservs)

Type of List Listserv Name Web Site

AHIMA Members Communities of Practice Go to http://www.ahimanet.org, and log in.Coders Advance Forum Go to http://www.advanceforhim.com, and click on

BULLETIN BOARD AND CODING.Medical Transcriptionists Advance Forum Go to http://www.advanceforhim.com, and click on

BULLETIN BOARD AND MEDICAL TRANSCRIPTION.Medicare Part B Claims PartB-L Go to http://lyris.ucg.com/cgi-bin/listserv/listserv.pl/partb-l

to enroll.Outpatient Coders APC-L Go to http://lyris.ucg.com/cgi-bin/lyris.pl?enter=apc, and join.

Federal Government Lists

CMS Press Releases and HHS_CMS_PRESS Go to http://list.nih.gov/archives/hhs_cms_press.html, and join.Facts Sheets

HHA/Hospice/CORF OTHER-PPS-L Go to http://list.nih.gov/archives/other-pps-l.html, and join.Prospective PaymentMailing List

HHS/HCFA HCFA-L Go to http://list.nih.gov/archives/hcfa-l.html, and join.(now called CMS)

HIPAA Regulations HIPAA-QUESTION Go to http://list.nih.gov/archives/hipaa-question.html, and join.Medicaid HIPAA HIPAAADMINSIMPL Go to http://list.nih.gov/archives/hipaaadminsimpl.html,

Administrative and join.Simplification

Long-term Care PPS LTCH-PPS-L Go to http://list.nih.gov/archives/ltch-pps-l.html, and join.Medicare Ambulance Ambulance-L Go to http://list.nih.gov/archives/ambulance-l.html, and join.

Fee Schedule Policyand Instructions

Medicare EDI Updates MEDICAREEDI-L Go to http://list.nih.gov/archives/medicareedi-l.html, and join.Medicare Home Health HH-PPS-L Go to http://list.nih.gov/archives/hh-pps-l.html, and join.

Prospective Payment List

Medicare Prospective PPS-L Go to http://list.nih.gov/archives/pps-l.html, and join.PaymentCommunication

News Releases Issued by HHS-OIG-MEDIA Go to http://list.nih.gov/archives/hhs-oig-media-l.html, and join.the HHS InspectorGeneral

Outpatient Prospective OP-PPS-L Go to http://list.nih.gov/archives/op-pps-l.html, and join.Payment System List

SUMMARY

• Health care career opportunities are available in many different settings and for a variety of types ofpositions.

• Cancer registrars collect and report cancer data togovernment and health care agencies.

• Coding and reimbursement specialists follow cod-ing guidelines when reporting codes for diagnoses,procedures, and services to third-party payers andgovernment programs.

• Health information managers are responsible forpatient record processing and maintaining the con-fidentiality of patient information.

• Health insurance specialists review claims for med-ical necessity to determine reimbursement.

• Health services managers plan, direct, coordinate,and supervise health care delivery.

• Medical assistants perform administrative and clin-ical functions in clinics and physician offices.

• Medical transcriptionists transcribe prerecordeddictation, creating medical reports.

• Other health information career opportunities in-clude health information consultant, medical officemanager, medical staff coordinator, privacy officer,quality manager, risk manager, utilization (case)manager, and vendor salesperson.

• The professional practice experience provides im-portant training for students in their field of study.

• The professional practice experience allows stu-dents to apply what was learned in class, and per-haps more important, prepares students for what isexpected on the job.

• From maintaining patient confidentiality to adher-ing to a professional code of ethics, students are expected to fully participate in the nonpaid profes-sional practical experience.

• Often, the professional practice experience leads toemployment opportunities for students while inschool and upon graduation. For this reason, andbecause students greatly benefit, they are encour-aged to join their professional association and toparticipate in Internet discussion forums.

STUDY CHECKLIST

• Read the textbook chapter, and highlight key con-cepts. (Use colored highlighter sparingly through-out the chapter.)

• Create an index card for each key term. (Write thekey term on one side of the index card and the con-cept on the other. Learn the definition of each keyterm, and match the term to the concept.)

• Access chapter Internet links to learn more aboutconcepts.

• Answer the chapter Exercises and Review ques-tions, verifying answers with your instructor.

• Complete the chapter CD-ROM activities.• Complete Web Tutor assignments and take online

quizzes.• Complete the lab manual assignment, verifying an-

swers with your instructor.• Form a study group with classmates to discuss

chapter concepts in preparation for an exam.

CHAPTER REVIEW

True/False: Indicate whether each statement is True(T) or False (F).

1. Once certified, a certified tumor registrar pays anannual fee to the NCRA and, therefore, does nothave to attend continuing education.

2. Coding and Reimbursement Specialists can obtainemployment in a variety of health care settings.

3. A health information manager processes a widerrange of skills than a certified coder.

4. Registered Health Information Technician job ti-tles include data quality manager, information se-curity officer, educator, and consultant.

5. Medical assistants examine, diagnose, and treat pa-tients under the direct supervision of a physician.

Multiple Choice: Select the most appropriate response.

6. A health care professional who has the primaryresponsibility of ensuring the timely, accurate,and complete collection and maintenance of can-cer data is known as a(n)a. cancer registrarb. coderc. health information managerd. medical staff coordinator

7. The two professional associations that offer certi-fication in coding area. AAPC, AHIMAb. AHIMA, CDCc. ICA, CDCd. NCRA, AAPC

52 • Chapter 2

8. AHIMA requires an RHIA to pay an annual con-tinuing education maintenance fee and to submitproof ofa. 20 hours of CE credits in a 3-year periodb. 30 hours of CE credits in a 3-year periodc. 20 hours of CE credits in a 2-year periodd. 30 hours of CE credits in a 2-year period

9. Which professional is required to pass a licensingexamination in all states and the District of Columbia?a. chief executive officerb. health information managerc. information systems managerd. nursing home administrator

10. Medical transcriptionists have unique skills thatenable them toa. code diagnostic and procedural informationb. enter information into computerized data

banksc. keyboard prerecorded medical dictationd. stage tumors according to SEER and TNM

Fill-In-The-Blank: Enter the appropriate term(s) tocomplete each statement.

11. The assignment of numbers to diagnoses, ser-vices, and procedures based on patient recorddocumentation is known as ________.

12. The Bureau of Labor Statistics states that employ-ment for the ________ profession is expected togrow faster than the average for all occupationsthrough 2010.

13. The insurance claims organization that offers cer-tification as a Certified Medical Billing Specialistis the ________.

14. The American Association of Medical Assistantscredentials medical assistants as ________ andthe American Medical Technologists credentialsmedical assistants as ________.

15. Each professional association has a(n) ________,which are judgments about what is right orwrong.

Short Answer: Briefly respond to each question.

16. Sally Smith is interested in pursuing a career as aphysician office coder. What is the most appropri-ate coding certification for her to obtain?

17. How has Internet-based technology allowed cod-ing specialists to work at home?

18. According to the American Health InformationManagement Association, health informationmanagers have specific areas of expertise. Statethe areas of expertise of health information managers.

19. List two professional organizations that credentialcoding specialists and give the credential titles.

20. Professional associations often allow students tojoin the association as student members. List the student benefits of joining a professional association.


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