Medical Records Specialists
Compile, process, and maintain medical records of hospital and clinic patients in a manner consistent with medical, administrative, ethical, legal, and regulatory requirements of the healthcare system. Classify medical and healthcare concepts, including diagnosis, procedures, medical services, and equipment, into the healthcare industry's numerical coding system. Includes medical coders.
Common Job Titles
- Health Information Technician (Health Information Tech)
- Medical Records Clerk
- Medical Records Coordinator
- Registered Health Information Technician (RHIT)
What You'll Need to Succeed
AI-generatedKey competencies for this occupation at a glance
- MindsetUphold patient confidentiality and data privacy standards when handling sensitive medical records in accordance with ethical, legal, and regulatory requirements.Advanced
- KnowledgeClassify medical diagnoses, procedures, and services into standardized coding systems (ICD, CPT, HCPCS) using encoder software and coding databases to ensure accurate reimbursement and compliance.Proficient
- KnowledgeEvaluate medical documentation for completeness, accuracy, and compliance with regulatory requirements in hospital and clinic settings, following HIPAA and healthcare industry standards.Proficient
- KnowledgeGenerate reports and statistical analyses on coding accuracy, reimbursement trends, and documentation quality using database tools such as Microsoft SQL Server, Tableau, and statistical software.Proficient
- KnowledgeValidate coded medical data for accuracy against DRG grouping and billing requirements to support proper reimbursement and prevent claim denials.Proficient
- KnowledgeOrganize medical records filing and retrieval systems using computerized indexing, document management platforms like Laserfiche, and chart tracking software to ensure timely access.Proficient
- KnowledgeApply electronic medical record (EMR) systems and health information management software to compile, process, and maintain patient medical records across multiple platforms including Epic Systems and MEDITECH.Developing
- KnowledgeAnalyze clinical documentation and physician notes to extract appropriate diagnostic and procedural information for coding assignment.Developing
- KnowledgeInterpret medical terminology, anatomy, and pathophysiology within patient records to ensure accurate coding and classification of healthcare services.Developing
- Hands-onOperate document scanning and imaging equipment including barcode scanners, flat-top scanners, and DICOM medical imaging systems to digitize patient records.Developing
- MindsetEngage with healthcare providers and interdisciplinary teams to clarify clinical documentation and resolve coding discrepancies.Developing
Wage Data According to the Bureau of Labor Statistics
Annual wage data for Medical Records Specialists (2024)
Estimated Total Employment (U.S.)
187,910
Wage Distribution by Percentile
Line chart of annual wages by percentile. U.S. is the solid line. 10th percentile: U.S. $35,780. 25th percentile: U.S. $41,600. 50th percentile: U.S. $50,250. 75th percentile: U.S. $64,070. 90th percentile: U.S. $80,950. Use the left and right arrow keys to move between percentiles.
- U.S.
| Metric | U.S. |
|---|---|
| 10% of workers earn the following or less | $35,780 |
| 10% of workers earn the following or more | $80,950 |
| Workers on average earn | $55,970 |
+ indicates wage is at or above the BLS reporting cap ($239,200/year)
Tools & Technology
Equipment and software commonly used in this occupation
In-Demand Technology
Frequently requested by employers in job postings
- Epic Systems
- Henry Schein Dentrix
- IBM SPSS Statistics
- MEDITECH software
- Microsoft Access
- Microsoft Dynamics
- Microsoft Excel
- Microsoft Office software
- Microsoft Outlook
- Microsoft PowerPoint
- Microsoft Project
- Microsoft SQL Server
- Microsoft SQL Server Reporting Services SSRS
- Microsoft SharePoint
- Microsoft Visio
- Microsoft Visual Basic
- Microsoft Windows
- Microsoft Word
- R
- SAS
- Structured query language SQL
- Tableau
- Teradata Database
- eClinicalWorks EHR software
Technology Skills
- 3M Encoder
- Allscripts EHR
- Amazing Charts
- American Medical Association CodeManager
- Azalea Health Azalea EHR
- Billing software
- Coding database software
- ComChart EMR
Tools & Equipment
- 10-key calculators
- Barcode attachment equipment
- Barcode scanners
- Credit card processing machines
- Desktop computers
- Dictaphones
- Encoders
- Flat-top scanners