Medical Claims Examining

Transcription

1 RRN 1,422 Medical Claims Examining April 2009 Needs Assessment Prepared by Carli Straight Date: April 30, 2009 Medical Claims Examining 1

2 Scope Data compiled in this report covers San Bernardino, Riverside, Orange, and Los Angeles Counties. Data were drawn from external sources, including the Employment Development Department s California Labor Market Information and the U.S. Department of Education s Integrated Postsecondary Education Data System (IPEDS), and Chaffey College s Colleague Administrative database. Data Sources and Calculations Educational Program Data The Taxonomy of Programs (TOP) is a standardized system used at the state level to classify programs and courses that are intended to achieve the same outcome at different colleges throughout the state. Medical Claims Examiner is one of many specializations under the Insurance TOP code, The Classification of Instructional Programs (CIP) is a standardized coding system used at the federal level to facilitate accurate tracking, assessment, and reporting of fields of study and program completion at educational institutions throughout the country. The CIP code for Insurance is All educational program data in this report are based on these TOP and CIP codes. Occupational Data The Standard Occupational Classification (SOC) system is used by federal statistical agencies to classify workers into occupational categories. The SOC title and code associated with Medical Claims Examiners is Claims Adjusters, Examiners, & Investigators, SOC All occupational data in this report are based on this code. Educational Program to Occupation Crosswalk The TOP-CIP-SOC Crosswalk (Employment Development Department, 2007) was used to map California Community College-specific Taxonomy of Program (TOP) codes to federal Classification of Instructional Program (CIP) and Standard Occupational Classifications (SOC) codes. This crosswalk allows the user to estimate labor market demand for California Community College program completers using SOC-based projections from the Labor Market Information Division. Industry Data The North American Industry Classification System (NAICS) is used by federal statistical agencies to classify business establishments for the purpose of conducting and reporting research on the U.S. business economy. Using the Standard Occupational Classification code for Claims Adjusters, Examiners, & Investigators, associated NAICS industries were identified. Completions Data Degree and certificate data regarding students at Chaffey College were collected from the Colleague Administrative database. Degree and certificate data for all comparison schools were collected from the U.S. Department of Education s Integrated Postsecondary Education Data System (IPEDS). 2

3 Introduction and Contents Contents Regional Job Outlook 4 Largest and Fastest Growing Industry Employers 6 Regional Graduation Summary 7 Sample Medical Claims Examining Program 8 Enrollment and Completion in a Similar Program at Chaffey College 9 Map of Selected Regional Employers and Competitor Institutions 10 Purpose and Goals Chaffey College does not currently offer a Medical Claims Examiner program. The purpose of this report is to integrate and analyze data from multiple sources to determine labor market needs for the addition of a Medical Claims Examiner program at Chaffey College. The report describes the regional job outlook and compares it to the number of recent graduates at other regional institutions. Comparison Institutions All comparison institutions included in this report are postsecondary and have provided data to the U.S. Department of Education s Integrated Postsecondary Education Data System (IPEDS). IPEDS defines postsecondary education as a formal program designed primarily for students beyond high school age. These include academic, vocational, and continuing professional education, and exclude avocational and adult basic education programs. Regional Definitions Inland Empire includes the Riverside-San Bernardino-Ontario Metropolitan Statistical Area (MSA) Los Angeles County includes the Los Angeles- Long Beach-Glendale Metro Division Orange County includes the Santa Ana- Anaheim-Irvine Metro Division Key Terms and Concepts Replacement Jobs: Replacement jobs refer to the number of job openings due to workers leaving an occupation. Annual Openings: Annual openings are calculated by adding the number of new jobs to the number of replacement jobs, divided by the number of years in the projection period. Projections: Projections of employment are calculated by the Employment Development Department and are based on a mathematical formula that includes historical employment and economic indicators along with national, state, and local trends. Occupation: Jobs are grouped into occupations using the federal Standard Occupational Classification (SOC) system. Industry: Occupations are grouped into industries using the North American Industry Classification System (NAICS). Wages: Hourly wages are reported in percentiles and averages. The 25 th percentile is a useful proxy of entry-level wages and the 75 th percentile of experienced-level wages. 3

4 Regional Job Outlook Projected Regional Job Outlook The table below displays 2006 employment estimates and 2016 projections for Claims Adjusters, Examiners, and Investigators. These data indicate that Los Angeles County currently supplies the greatest number of jobs and will produce the most annual total job openings over this ten-year time period. Total Estimated 2006 Jobs Total Projected 2016 Jobs Projected Growth (%) Ave. Annual New Job Openings Ave. Annual Replacement Job Openings Ave. Annual Total Job Openings State of California 31,200 35,000 3,800 (12.2%) ,180 Inland Empire 1,930 2, (14.0%) Los Angeles CO 8,520 8, (2.6%) Orange CO 5,170 5, (11.0%) Source: Labor Market Information Division, Employment Development Department, Occupation Profile, Claims Adjusters, Examiners, and Investigators, on the Internet at: (visited April 07, 2009). Projected Regional Job Growth The graph below displays the projected growth of Claims Adjuster, Examiner, and Investigator occupations from 2006 to As indicated, Los Angeles County is expected to demonstrate very little growth over this time period. Although the Inland Empire and Orange County will experience relatively more growth, the rate of increase in both counties is slower than the average of all other occupations. % Growth California Inland Empire Los Angeles County Orange County Source: Labor Market Information Division, Employment Development Department, Occupation Profile, Claims Adjusters, Examiners, and Investigators, on the Internet at: (visited April 07, 2009). 4

5 Regional Hourly Wages This table displays the 2009 hourly wage statistics of Claims Adjusters, Examiners, and Investigators. All in all, wages are fairly equitable across the regions of comparison. An employee in this occupational group can expect to earn between $22 and $37/hr, depending on experience. Mean Hourly Rate 25 th Percentile Median Hourly Rate 75 th Percentile State of California $29.60 $22.76 $29.20 $36.27 Inland Empire $29.83 $24.13 $30.07 $35.99 Los Angeles CO $28.27 $21.69 $27.75 $34.89 Orange CO $30.05 $22.73 $30.23 $36.90 Source: Labor Market Information Division, Employment Development Department, Occupation Profile, Claims Adjusters, Examiners, and Investigators, on the Internet at: (visited August 09, 2009). 5

6 Largest and Fastest Growing Industry Employers Largest Industry Employers for Claims Adjusters, Examiners, & Investigators The graph below displays the 2006 staffing patterns of the ten largest industries employing Claims Adjusters, Examiners, and Investigators across the state of California. As indicated, Insurance Carriers employed the most individuals in this occupation, followed by Insurance Agencies, Brokerages & Support, Federal Government, and State Government. 14,000 Number of Employees 12,000 10,000 8,000 6,000 4,000 2,000 Insurance Carriers Insurance Agencies, Brokerages, & Support 0 Federal Government State Government Management of Companies & Enterprises Office Administrative Services Local Government Employment Services Offices of Physicians Travel Arrangement & Reservation Service Source: Labor Market Information Division, Employment Development Department, Staffing Patterns, on the Internet at: (visited April 15, 2009). Change Over Time of the Largest Industry Employers of Claims Adjusters, Examiners, & Investigators The graph below displays the growth patterns from of the ten largest industries employing Claims Adjusters, Examiners, & Investigators in the state of California. The data indicate that only half of these industries are expected to grow, with Employment Services demonstrating the largest increase, followed by Office Administrative Services, Insurance Agencies, Brokerages, & Support, Local Government, and Insurance Carriers, in order % 50.00% Percent Change 40.00% 30.00% 20.00% 10.00% 0.00% Insurance Carriers Insurance Agencies, Brokerages, & Support Federal Government State Government Management of Companies & Enterprises Office Administrative Services Local Government Employment Services Offices of Physicians Travel Arrangement & Reservation Service Source: Labor Market Information Division, Employment Development Department, Staffing Patterns, on the Internet at: (visited April 15, 2009). 6

7 Regional Graduation Summary Education and Training General duties of a Claims Examiner include reviewing and analyzing claims, negotiating settlements, and authorizing payments to claimants. Most Examiners work for life or health insurance companies reviewing health-related claims to determine if the charges are reasonable and in line with the medical diagnosis. After review, Examiners decide whether to authorize payments or refer the claim to an Investigator, in cases of suspected fraud. A successful Claims Examiner will possess skills in persistence, assertiveness, communication, and the ability to deal with confrontation. 1 Claims Adjusters, Examiners, and Investigators should have a minimum of a high school diploma or equivalent, however, employers prefer to hire college graduates or individuals who have completed some postsecondary or long-term on-the-job training. 1 In California, 46.7% of working Claims Adjusters, Examiners, and Investigators between the ages of 25 and 44 years possess a bachelor s degree or higher, 35.1% have attended some college, and 18.3% have a high school degree or less. 2 A medical background is useful for Examiners working on medical and life insurance claims. Instructional topics should include health and medical insurance processes and procedures, health insurance law and regulations, health care industry law, record-keeping, analytic and investigatory techniques, evaluation methods, field operations methods, office procedures, related software applications, oral and written communication skills, interviewing techniques, and professional standards and ethics. 1 Regional Completers in Medical Claims Examiner Programs The table below displays the number of program completers in the school year at regional institutions offering an associate s degree or certificate in Medical Claims Examining. Ladera Career Paths Training Center is the only institution in the area with completers. Award Level Institution Name < 1 year Certificate 1 to < 2 year Certificate Associate s Degree Chaffey College American Pacific College Four-D College Ladera Career Paths Training Center Total Note: -- indicates that this type of degree is not offered. 0 indicates that this degree is offered but no degrees or certificates were granted. Source: National Center for Education Statistics, U.S. Department of Education, Integrated Postsecondary Education Data System, on the Internet at: 1 U.S. Department of Labor Occupational Information Network (O*NET) 2 California Labor Market Information Occupational Guides 7

8 Sample Medical Claims Examining Program Medical Claims Examining Program at Other Regional Institution Ladera Career Paths Training Center (LCPTC) is one of the only postsecondary institutions offering a certificate in Medical Claims Examining in the four county region. The table below illustrates the LCPTC courses required to earn a certificate in Medical Claims Examining, as well as comparable Chaffey College courses. LCPTC Course LCPTC Course Description LCPTC Class Hours Comparable Chaffey Course Module I Computer Basics 75 BUSTOT 61/62/63A/64A Microsoft Office series Module II Module III Medical Terminology, Anatomy, & Physiology Basic Medical Terminology, Anatomy, & Physiology Advanced 32 BIOL 30 Beginning Medical Terminology 95 BIOL 424 Anatomy and Physiology Module IV Pathophysiology and Pharmacology 80 Module V ICD-9-CM Coding Basic 32 BUSTOTMD 420 Basic ICD-9 CM Coding Module VI ICD-9-CM Coding Advanced 100 BUSTOTMD 430 Intermediate Level ICD- 9 CM/CPT4 Coding Module VII Current Procedural Terminology Coding Basic 32 BUSOTMD 408 Coding of Body Systems for Medical Coding and Billing Module VIII Current Procedural Terminology Coding Advanced 95 Module IX Medical Billing Basic: Practical Application BUSOTMD 408 Coding of Body Systems for Medical Coding and Billing Module X Medical Billing Advanced: Practical Application 50 BUSOTMD 440 Medical Billing, Reimbursement, and Compliance Module XI Health Claims Examining: Practical Applications 125 Module XII Health Claims Examining/ Medical Billing Unpaid Internship 80 8

9 Enrollment and Completion in a Similar Program at Chaffey College Description of Medical Insurance Billing Chaffey College currently offers a certificate in Medical Insurance Billing, which draws on many of the same skills involved in Medical Claims Examining. A description of the Medical Insurance Billing program in the Course Catalog reads: The Medical Insurance Billing Certificate offers a study of the medical front office, including office procedures, medical law and ethics, scheduling appointments and surgeries, billing and collection, records management, and physical coding for insurance billing. Aspects that are similar to the Medical Claims Examiner training currently in place at Ladera Career Paths include the study of office procedures, medical law and ethics, billing and collection, records management, and physical coding for insurance billing. This program might be used as a model for the addition of a Medical Claims Examiner program at Chaffey. Certificate and Enrollment Data for Medical Insurance Billing Enrollment To estimate the annual student enrollment in a Medical Claims Examiner program at Chaffey College, the enrollments of students in related courses were identified. The table below depicts the number of students at Chaffey College enrolled in courses that might be required to earn a certificate in the Medical Claims Examiner program. Course Course Description Fall Term BUSOTMD-408 Coding of Body Systems for Medical Coding and Billing BUSOTMD-420 Basic ICD-9 CM Coding BUSOTMD-430 BUSOTMD-440 Intermediate Level ICD-9 CM/CPT4 Coding Medical Billing, Reimbursement, and Compliance Note: Enrollment numbers reflect all students who either enrolled after the start date, enrolled prior to the start date, or dropped after the start date. Certificate Completion The annual student completers from the through Academic Year in the Medical Insurance Billing program at Chaffey College were also identified to estimate the number of completers that might be expected in a Medical Claims Examiner program. Academic Year Total Certificate Completions

10 Map of Selected Regional Employers and Competitor Institutions Direct Health/Medical Insurance and Life Insurance Carriers are the top industry employers of Medical Claims Examiners in the state of California. Across all four counties, there are 143 industry employers listed by the California Labor Market (83 in Los Angeles County, 44 in Orange County, 9 in Riverside County, and 7 in San Bernardino County). This map illustrates the location of those Direct Health/Medical Insurance and Life Insurance Carriers listed by the California Labor Market which include address information. Also included in the map are the locations of Chaffey College and other competitor institutions offering degrees or certificates in Medical Claims Examining. 10