Posted on Monday, December 17, 2012
In the early days of healthcare BPO, basic claims processing (data entry) jobs used to be outsourced to India from the US. However, India has now established itself as an outsourcing destination of choice for the medical coding work, which is a complicated process. Over the last two years, more and more of the in-patient coding work is being outsourced to India and is by far the most complex coding work.
There is also a lot of growth in the claims adjudication space and other insurance company related work that is being done in India. While most of the healthcare services work comes from the US today, there are other countries that will join the fray in the next few years. However, the US continues to be the leader as it has the most complex healthcare administrative/reimbursement process ever.
Claim processing and settlement, i.e. healthcare revenue cycle management, is one of the most important and core services in the health insurance industry and has to be handled promptly and accurately. A career in claims processing involves several areas of expertise that an individual can develop. Careers in the claims processing industry offer a range of opportunities for people with different skills-sets.
For example, graduates with degrees in zoology, microbiology, biochemistry, physical therapy, homeopathy, and any other fields of life science have an opportunity in the medical coding specialty and can be trained in a specialised skill-set that is highly in demand. There are also jobs available for people with good typing skills and other graduates with good communication skills and ability to converse fluently in English. For career growth, a fresher needs to stay in the profession for a couple of years to become proficient and grow as a subject matter expert or as a front line manager to manage different types of processes and teams.
The US healthcare industry is about $1.8 trillion in size, by far the single largest industry in the US economy, and is expected to be about $2.5 trillion by 2018. The healthcare revenue cycle market (claims processing) is estimated to be about a $11 billion segment. That represents only the provider segment. Out of this, the market that is outsourced is around $3 to $4 billion, out of which there is only about $300 to $400 million worth of work being done in India currently.
The global healthcare BPO market is growing at a CAGR of 21.4%. Pharmaceutical outsourcing accounts for the largest share of 64.3%, but will grow at a CAGR of 14.6% from 2011 to 2016 since the market is saturated. Healthcare provider outsourcing has the highest growth rate of 31.9% from 2013 to 2018 because of the conversion from ICD-9 coding system to ICD-10 coding system to be implemented by October 2014 in the US. Healthcare payer outsourcing market will also grow at about 30% in the forecast period.
Medical coding by far offers several growth opportunities. The healthcare reform in the US will also drive the need for a lot more processing, as more people will get covered by the health insurance system. The ICD-10 implementation requirement by October 2014 in the US is expected to be as big as the Y2K conversion in terms of opportunities offered.
For medical coding, a degree in any field of life science is a requirement so they can be easily trained to read medical charts and other complex processes. For voice-based and analytical work, any graduate with good analytical ability is good to start with. For data related work, good typing skills are a must with decent analytical skills. However, considering time zones, for international BPO companies, willingness to work in the night shift will be an added advantage.
At an entry level, the average annual pay is somewhere between Rs 1 and Rs1.5 lakh, depending on the type of work and the skill-set required. Depending upon the employees upgrading their skill and proficiency, they could earn on an average Rs 2 to 3 lakh per annum in 24 to 36 months. Based on the process, complexity and an employee’s performance, they have the ability to move to entry and mid-management levels where the pay scales tend to be more attractive (Rs 4 to 12 lakh and more per annum). At the senior management levels, the remuneration is a lot more attractive and could run anywhere between Rs 15 and 65 lakh, based purely on background and performance.
— As told to Aaditi Isaac
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