Medical Records and Health Information Technicians/Medical Coders

Recognized Skill Standards
September 13, 2019


The Medical Records and Health Information Technicians/Medical Coders competency-based occupational framework was submitted for skill standards recognition by Healthcare Career Advancement Program (H-CAP), which participated in the frameworks’ development. H-CAP is a national labor/management organization that promotes innovation and quality in healthcare career education. Its board includes Service Employees International Union locals and healthcare employers across all sectors of healthcare. H-CAP’s mission is to transform healthcare workforce development and education to support and engage a well-trained and valued workforce to better meet the need for quality care in a rapidly changing industry. 


The development of the occupational framework was updated in December 2017, facilitated by the Urban Institute under a grant from the U.S. Department of Labor (DOL). The grant funded an initiative to identify the content (industry competencies) and worker qualifications required to perform in various occupations. The Medical Records and Health Information Technicians/Medical Coders framework meets the definition and recognition criteria for Texas skill standards. The DOL grant required a rigorous development and validation process that adhered to standard job analysis methodology, including convening industry subject matter experts to identify the work-oriented information and validation by a wider range of practitioners in the occupation. 

The Medical Records and Health Information Technicians/Medical Coders framework is composed of the following five job functions: 1) properly applies diagnosis and procedure codes to medical charts, records, and related documents; 2) supports documentation of care for services provider reimbursement process to ensure timely and accurate payment; 3) maintains accurate and complete patient health records; 4) ensures compliance with healthcare law, regulations, and standards related to information protection, privacy, security, and confidentiality; and 5) maintains appropriate technology solutions including health information systems to support healthcare delivery and organizational priorities. 

Comparing Competency-Based Occupational Frameworks to Texas Skill Standards

The competency-based occupational frameworks have a different format and nomenclature than skill standards recognized in Texas. But the content is the same, and the elements that constitute the frameworks are equivalent to the elements that constitute skill standards. Skill standards elements are composed of work-oriented information, describing the critical work functions, the key activities that make up those functions, and the performance criteria or proficiency level to which the activities must be performed. The occupational frameworks are also composed of these work-oriented elements, called job functions, competencies, and performance criteria, respectively. 

Skill standards are also composed of worker-oriented information, which specifies the skills and knowledge required of the worker to perform the work. The worker-oriented elements include: 

  • Academic knowledge and skills – the level, indicated by a numerical rating, of reading, writing, math, and science required to perform each critical work function.
  • Employability knowledge and skills – the level (numerical rating) of “soft” or transferable skills, common to all occupations, required to perform each critical work function. 
  • Occupational skills, knowledge and conditions – the technical skills and knowledge that are occupation-specific, and the tools, resources, and equipment, required to perform each key activity.

The occupational frameworks are composed of the same worker-oriented elements. The frameworks’ cross-cutting competencies are the equivalent of both the academic and the employability knowledge and skills. The level of each competency is also rated. However, the rating applies to the level of each competency required to perform all the functions across the occupation rather than each work function, as in skill standards. Definitions of the cross-cutting competencies can be found on DOL’s Competency Model Clearinghouse website. The scoring system used to evaluate the level of competency required in each cross cutting skill can be found on the Lumina Foundation’s Connecting Credentials Framework website. For these website links, see the Cross-Cutting Competencies section of each occupational framework. 

In the occupational framework, the equivalent to the standards’ occupational knowledge and skills is called related technical instruction. That element includes occupation-specific knowledge and skills, and the tools and technologies required to perform each job function rather than each key activity, as with skill standards. 

For a side-by-side comparison of the equivalent elements, see the Skill Standards to Occupational Equivalencies link on the Texas skill standards repository web page.

Importance to Texas

Medical records and health information technicians/medical coders use coding conventions and guidelines to abstract, analyze, and accurately assign International Classification of Diseases, Current Procedural Terminology, and other classification systems, as well as principal and secondary diagnostic and procedural codes to inpatient, ambulatory, and outpatient medical records. Coding professionals also query physicians when diagnosis is unclear, audit records, and perform peer reviews.

According to Texas Workforce Commission data, medical records and health information technicians/ medical coders are projected to grow 21.6 percent by the year 2026, and employ 21,111 Texas workers. The median annual wage in 2017, the latest data available, was $37,883.


On September 13, 2019, the Medical Records and Health Information Technicians/Medical Coders competency-based occupational framework was recognized as skill standards in accordance with the Guidelines for the Development, Recognition and Usage of Skill Standards.