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For other articles and previous issues click here. July 26, 2004 Experience
Wanted Industry experts offer suggestions on how the newly certified can get around the desire for experienced coders only. When Mercedes Herskowitz was looking for a career change, her love of science and medicine drew her to the coding profession. Her interest was buoyed by the knowledge that coders are in short supply and opportunities are plentiful. She completed a year-long certificate program at a local college with an A average and a clear sense of aptitude for the profession. Then she began the job search in earnest, not only sending resumes in response to every opening that came to her attention but also networking and calling HIM directors to explore possibilities. Soon, she came head to head with a dispiriting catch-22: Employers aren’t interested in a coder without experience or certification, yet it’s nearly impossible to get experience and become certified without employment. While her training program offered knowledge about the fundamentals of coding, it neglected to address the harsher facts of the profession. The catch-22 conundrum was not discussed by her teachers, and strategies for landing a position were not stressed. Herskowitz enjoys the challenge of coding and says she’d likely have pursued a career in the field despite the obstacles. Still, she says, she might have thought twice had she realized how uphill and long-lasting the battle would be. “I’ve met several directors and I know the pressures they’re under,” she says. “They need to produce and they don’t have the time to sit down and train somebody. But we need to start somewhere. I’m new, I’m fresh, and I’m eager to learn. Like anyone in a new role, I need training; but if someone has the patience to train me, I know that I can do well.” Despite Herskowitz’s enthusiasm, the doors aren’t opening. “How does one get their foot in the door when no one is willing to give a new coder a chance?” she wonders. What’s a Neophyte to Do?
Aspiring coders have heard that there’s great demand and huge opportunity in the profession. “That’s all true,” says Draper, “but the demand is primarily for experienced coders.” At Certus, she hires only credentialed coders with a minimum of three years’ experience. “Operational issues in the HIM profession today are such that everyone is trying to do more with less,” says Theresa Benavidez, RHIA, director of HIM at Seton Medical Center, Austin, Tex. In such an environment, taking on and training an entry-level coder is a complicated and time-consuming prospect. “It takes anywhere from one to two years to get an entry-level coder—someone with book learning but no hands-on experience with code assignments—up to speed,” she says. New coders need to understand the pressure for productivity that drives HIM directors. “In college or school, you have the amount of time you want to spend on a chart, but that’s not the case in hospitals, where you need to code a required number of records per day,” says Draper. “Most [HIM directors] don’t have the time to train people. That’s why most don’t want anything to do with novice coders. When you’re training someone else, you’re not getting your own work done.” “Most hospitals do not want to hire inexperienced coders,” admits Beth Friedman, RHIT, director of marketing, eWebHealth, who points out several compelling reasons. “Healthcare providers are under strict monitoring and are subject to heavy fines when it comes to clinical coding. They are under the microscope every day by hospital executives as well as the payors. There is no room for mistakes or inaccuracies.” A reluctance to hire those who haven’t proved themselves in similar clinical settings, she says, creates a no-win situation for both the coders and hospitals suffering from a critical shortage of experienced coders. It’s clearly not easy to break into the coding ranks, and many would-be coders expecting to land a job straight out of school are dismayed by the lack of prospects and the slow pace of apprenticeship. Nevertheless, those who evaluate and hire coders suggest that the quest is not impossible. To gain an edge, novice coders can employ several strategies, including receiving the best possible training, looking beyond hospitals for employment, volunteering, and searching for mentoring opportunities. Education and Clinical Practice
“Anyone planning on entering the coding field should be sure that the educational program they’re taking includes a large percentage of clinical practice in the coding setting,” says Friedman. Whenever possible, she adds, clinical practice in coding should be extended through volunteerism. “New coders should look for every opportunity to maximize their exposure to coding during the clinical practice and be sure to network with the other coders, supervisors, managers, and practice directors during their stay at the facility.” After students complete their coursework, Draper advises them to take an extra class in the college “coding laboratory” to gain experience coding real charts and reading actual physicians’ handwriting. In addition, she says, the RHIT program offers two semesters of clinical practice in hospitals, which she claims is an excellent way for someone to get a foot in the door. “If you do well in those directed practice assignments, you may be able to prove yourself worthy of hire,” she notes. Coding managers advise newcomers to look for a coding program approved by the American Health Information Management Association (AHIMA) as a guarantee of solid education. According to Rita Scichilone, MHSA, RHIA, CCS, CCS-P, CHC, director of coding products and services at the AHIMA, the CCA (Certified Coding Associate) examination might be daunting for those who attend brief courses or coding boot camps, but there are excellent success rates for those who go through the AHIMA’s Coding Basics or attend programs with an approved AHIMA curriculum. “Everybody wants 100% accuracy when they submit coded data, so the risks are high,” she says. “If a candidate has a solid educational background, that mitigates the risk and gives the employer confidence that the coder will have a thorough knowledge base and understand the implications and technical sides of coding, as well as have an appreciation for the ethical and professional standards that are required to do the job.” Scichilone advises those having difficulty securing a position to take another look at their career development marketing tools. When judging job candidates, employers look at technical skills, she notes, but they also value other assets, such as communication skills. Job hunters, therefore, may benefit by improving their interviewing skills and refining their resumes. A Helping Hand: Mentoring Programs
The rise of home-based coding programs, explains Friedman, has helped to set the stage for the proliferation of mentoring possibilities, which until now have been largely impossible because of tight schedules and inflexible quotas. In many cases, Friedman says, remote coding arrangements have resulted in dramatic improvements in coder productivity, which can leave experienced coders with a bit more time on their hands. She points to the example of Seton Medical Center, where such an in-house training program is a model of mutual cooperation. “Relationships were developed, senior coders were given the opportunity to help others by becoming coding mentors, and the hiring organization was able to feel confident in the coding skills of the new hires,” Friedman says. At Seton, Benavidez has created a successful mentoring program that’s helping her ensure that the coding shortage will not slow down her department while she’s providing opportunities for entry-level coders. This in-house training program, as Friedman notes, made another of Benavidez’s winning initiatives possible: a remote coding program that decreased turnover. The improved retention rate made it possible to give the department the stability it needed to divert time and energy into an effort to mentor a new pool of potential talent that will turn into a stable of long-term employees. Benavidez employs 18 coders, four of them entry-level. The latter have completed a 30-hour community college “HIM tech” course that focused on code assignment and anatomy and physiology. Most of these novices were already employed in the HIM department and given the opportunity to move into coding as positions opened and when the department was able to be supportive. “They expressed a need,” says Benavidez, “and we saw it as a career ladder for them. They went off and got some education, came back and interviewed, and actually were screened and tested to see if they could qualify for entry-level positions.” Seton had two slots at one campus and was able to accommodate each of the two coder wannabes. At another campus, however, it had only one position for which several people were vying. Selections, says Benavidez, were based not only on how well they did on the test but also on their overall interview performance. Once in the training program, novice coders are mentored in the coding of outpatient records, either those pertaining to ancillary services or emergency department (ED) visits. The work on ED charts, Benavidez explains, is more intense because it involves HCPCS (Healthcare Common Procedure Coding System) CPT (Current Procedural Terminology) code assignments. Therefore, 100% of their work is monitored for approximately 90 days. Seton’s lead coder is responsible for the training and monitoring, and because she’s thus pulled into a nonproductive role while mentoring and reviewing, the rest of the coding staff must absorb her work. Consequently, training is offered only when the department is fully staffed. Training is put on hold during staffing interruptions, such as vacations, and new coders are assigned to work only on charts at the skill level they’ve already achieved. When the staffing situation returns to normal, training resumes. To ensure flexibility and prevent frustration and false expectations of uninterrupted training and advancement, this catch-as-catch-can approach is explained in advance. Ascension Health System, the corporation that comprises Seton, has purchased a suite of online training programs for coding, and Seton’s HIM department is exploring the possibility that it can support the training process. “They [staff] won’t take the place of a trainer, but they possibly can assist with some key concepts and learning,” Benavidez says. Seton has already advanced two of its novice coders to a level at which they’re beginning to work with day surgery and observation visits. “It’s been an ongoing effort for us, trying to move them along in addition to balancing our workload,” says Benavidez. She notes that the logistics of such a mentoring effort are not simple, but the task is rewarding for all involved. “It takes time, patience, and flexibility on everyone’s part,” she says. “It’s allowed us to provide for an internal career ladder within our department.” A secondary motive, Benavidez says, was to grow their own coders. “If we invest the effort now, it will be beneficial in the future and we’ll have the ability to backfill positions, keep people moving up, and continue bringing in entry-level people. It’s a win-win situation.” Getting a Foot in the Door There’s a whole untapped world of opportunity, suggest Benavidez and Scichilone, outside of the hospital environment. “A great way for new coders to break in is to market themselves to physician offices, for example, because physicians are increasingly recognizing the need for accurate information,” says Benavidez. She recalls that one of her trainees came from such an environment, and as a result of that experience was able to be brought up to speed quickly on ED records. Other venues that may be springboards into acute care facilities, she says, are nursing homes and ambulatory surgery centers. Experience at such venues is valuable, she explains, “because if HIM managers can hire individuals who can, at minimum, handle the outpatient code assignments, it frees the more experienced coders to tackle the more complex cases.” Experts agree on a roundabout approach when the going gets tough. If you lack the desirable amount of experience for a coding position, look for another type of position within an HIM department for which your skills and experience are adequate and in which you can progress, hone, and exhibit your coding skills. For example, says Benavidez, at Seton there is an administrative support position for the coding staff that involves tasks such as tracking down records, monitoring unbilled charts, and helping remote coders with assignments. “That’s a good feeder for someone who wants to move into coding, and we’ve had several people move from that position into entry-level coding,” she says. Kutish says landing any position in the HIM department could be a good place from which to launch a coding career. “Once in the medical records department, coders can ask the supervisor if they can code some records on their own, which would give them a jump on people who don’t have that experience,” she says. That way, they could learn without taking time away from the manager or supervisor. “There’s just no right, easy answer for someone trying to break in,” acknowledges Benavidez. Scichilone says combine a healthy dose of hard self-assessment and a concerted effort to network and new coders will be on their way. She suggests aspiring coders should recognize the value of networking, be proactive, and manage their own careers. It may not be easy, but with realistic expectations, education, perseverance, and practice, aspiring coders can make the leap into the profession. — Kate Jackson is a staff writer at For the Record. A New Certification and Networking Opportunities
for Entry-Level Coders Membership in a professional association can help coding professionals find unique opportunities through the networking process—a vital “first step” in a job search. AHIMA coding roundtables are active in locations throughout the country and can be a great place to discover job openings even before the openings are advertised. For more information, visit www.ahima.org and click on HIM Resources: Coding for the details. — KJ |
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