Health care is a business. Like every other business, it needs good management to keep it running smoothly, especially during times of change. The structure and financing of health care is changing rapidly. Occupational demand in the insurance sector has grown, especially in companies involved with managed health care programs, which include Health Maintenance Organizations (HMOs). The national trend toward managed health care has increased concerns about the oversight of patient care. Medical administration and health services professionals plan, organize, coordinate and supervise the delivery of health care. They strive to improve efficiency in all health care facilities, while continually improving quality of the health care provided.

Health services managers include both generalists—administrators who manage or help to manage an entire facility or system—and health specialists—managers in charge of specific clinical departments or services found only in the health industry.

Every time health care personnel treat a patient, they record what they observed, and how the patient was treated medically. This record includes information the patient provides concerning their symptoms and medical history, the results of examinations, reports of x-rays and laboratory tests, diagnoses, and treatment plans.

Health information technicians, or medical record technicians, organize and evaluate medical records for completeness and accuracy.

Medical transcriptionists translate and edit recorded dictation by physicians and other healthcare providers regarding patient assessment and treatment.

Companies providing health care and health care insurance are looking for workers with higher levels of skills and knowledge. All occupations in the insurance sector are identified as evolving occupations in Texas, and are associated with firms engaged in managed health care. The fact that Texans have been slow to move to managed health care compared to the national average suggests that HMOs will expand marketing efforts across the state to increase the number of customers and attract physicians to join the programs.

Provider relations specialists use backgrounds in marketing or finance to establish and maintain relations between health care providers (physicians, clinics and hospitals) and purchasers (HMOs or insurance companies). They are responsible for recruiting health care providers and for negotiating and administering contracts between providers and purchasers. Provider relations representatives may work for insurance companies, management services firms, and health care providers.

As HMOs are profit-driven organizations, cost-controls are vital to their profitability. Advances in technology, new medical diagnosis and treatment techniques are typically developed at high costs. With all of the treatment options available, many patients feel the newest, and often most costly treatment is the only satisfactory option.

Compliance officers and utilization review coordinators monitor appropriate resource use to help HMOs manage these costs. Utilization reviewers, typically a hospital based position, are now in demand by a variety of employers, including managed health care organizations and insurance companies. In fact, firms that specialize in utilization review offer their services on a contract basis to other firms as well as to patients who want to make sure all prescribed procedures are necessary. Utilization reviewers often have nursing degrees or other medical training (see also Nursing and Patient Care).

Administrative support occupations include:

Medical eligibles specialists and admitting clerks work in hospitals, doctors' offices and other health care facilities. They interview patients to obtain all preliminary information required for admission. They also determine eligibility in light of HMO policy standards and process the paperwork of new applicants and patient admissions (see also Office Technology).

Insurance claims clerks process paperwork of covered individuals. They make sure all required documentation has been submitted. They also arrange reimbursement to the medical treatment provider or customer as needed (see also Office Technology).

Medical secretaries transcribe dictation, prepare correspondence, and assist health services managers, physicians and medical scientists with reports, speeches, articles and conference proceedings (see also Office Technology).

 

Health care managers and administrative support personnel generally work in clean, well-lit, attractive and comfortable offices, usually in hospitals, clinics, doctors' offices and insurance companies. Most administrative employees work a 40-hour week, but in facilities that operate around the clock, this may include night, weekend and holiday shifts.

 

Health care administrative professionals should have a variety of business skills, as well as the skills they possess in their area of expertise. They should have strong interpersonal skills and a neat, professional appearance, as they often work with the public in highly visible areas. Medical records personnel should be detail-oriented and precise, as accuracy is imperative in medical and insurance records. Managers should have strong leadership abilities, as they may oversee a large staff.

 

Opportunities in the health care industry should continue to expand. Faster than average growth will be driven by technological advances in patient care, which permit a greater number of medical problems to be treated, and increasing emphasis on primary care. In addition, the number of older people, who are much more likely than younger people to need medical care, is projected to grow very rapidly. HMOs and other managed health care providers will continue to provide opportunities for specialized administrative professionals.