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"Men went mad and were rewarded with metals."
Joseph Heller, Catch-22
In Hollywood they say you're nothing without an agent, but you can't get an agent if you don't have work. There are those in health information management (HIM) who have their theories on why a similar catch-22 prevails for would-be coders. The word problem reads something like this: How is it true that both a) there is a coding shortage, and b) there are people trained to code who can't get hired? But in solving for X, there may be some common denominators concerning applicants' education, employers' experience requirements and job seekers' overall perseverance that factor into a person's chances to break into coding.
Supply Here, Demand There
"There is a shortage of people doing coding," confirmed Claire Dixon-Lee, PhD, vice president of accreditation and education at the American Health Information Management Association (AHIMA). "But it isn't necessarily a case of coders not being produced."
And the shortage is even more prevalent in rural areas. "I have noticed in my 20+ years of hiring coding professionals that some coders are not willing to relocate," observed Susan Nothom, director of HIM at Memorial Medical Center in Las Cruces, NM. "From comments I have heard it seems that there are an abundance of them in large metropolitan areas, but for some reason they don't want to relocate where there are scarcities" even when a facility offers to cover moving expenses, Nothom added.
"I feel to get your foot in the door, sometimes you have to find one that's open, be it a little farther away," said Cherie Tafoya, CCA, a coder at Lake Regional Health Care Systems in Osage Beach, MO. That's why she moved after completing a two-year coding certificate program and her practicum at an orthopedic office. "I moved to another state and with my hospital and orthopedic experience, they hired me" albeit, on condition. "It was agreed that I had to get a certification."
Experience, Credentials Required
"Hospitals are screaming for coders," said Camille Perrin, CPC, from Palm Beach Gardens, FL, "if they are certified coding specialists (CCS), have three to five [years] in hospital coding, period."
"It's an issue of bridging that experience gap between leaving an academic program or any kind of formal education, to getting that first job in coding," noted Dr. Dixon-Lee. Bridging that gap takes time.
Often, "There isn't enough time in the day for a supervisor in coding to work with a recent grad to help him/her over that learning curve from academic practice to develop the speed and accuracy needed to do the job." Many employers assume previous experience and/or credentials negate such training.
But now employed and CCA-certified, and with her sights on the CCS credential, Tafoya thinks there's a way around those applicant requirements. "Even if a job asks for credentials, I would still go talk to them."
"If I had a choice between a new graduate or an experienced coder, I wouldn't necessarily choose the experienced coder," said Nothom. "In the past years when I had a coder vacancy, I would interview and test everyone who provided documentation that they had prior coding experience or that they had coding education from a legitimate program."
In fact, said Nothom, "I have hired several recent graduates of health information technology programs or programs specifically aimed at turning out someone who could code. I have also had to train from within because I could not find someone with education or experience."
Nothom cited the expense of placing classified ads that don't seem to generate responses in her decision to train in-house, but her comments on the quality of an HIM program raise the education preparation issue.
"I do think that a two-year coding program teaches more about coding than any registered health information technician (RHIT) program," observed Tafoya. "In the past, I worked with RHITs and administrators (RHIAs) who could not code very well. Every CCS I have met is just an incredible coder." These aren't the only training options for a would-be coder, but the burning question for many grads is, will I be employable when I'm done?
Gold Brick Road or Brick Wall?
"I ventured into coding after more than 25 years in the financial services industry," Perrin recalled. "Most of the students I was in class with were a) considerably younger, b) had been involved in health care in various clerical functions and c) were lead to believe (as I was) that medical coding was the employment gold brick road. We were hyped by the school that there was a terrible shortage and that we would be employable at a high hourly rate of pay upon completion of the program." Even after sitting for the certified professional coder (CPC) credential, she laments, "I've been brick-walled at every turn."
For example, "I was told by an HR person at a large hospital [in my area] that I could start in medical records at $5.75 an hour and work my way up," said Perrin. And on the physician front, her thanks-but-no-thanks responses include: "It's all done by computer," "I have a girl who does that for me," or "Can you draw blood, too?"
Quality Ed vs. Matchbook U
"I wonder if the people who can't get hired due to lack of experience went through a coding program that did not require a significant non-paid professional practice," speculated Michelle Green, professor at Alfred State College in New York. Internships are what get grads jobs in her view. "Our coding and reimbursement specialist program requires students to complete a 240-hour, non-paid coding professional practice in a hospital HIM department. This usually turns into employment for them at that site; or, if not, at another site in the area because the individuals who mentor them at the hospital are willing to assist the student in finding employment."
If going away to study on a college campus isn't an option for those embarking on a second career, programs like Green's offers a distance learning option through the Internet (see www.alfredstate.edu). A national list of campus-based and online programs accredited by AHIMA is available at www.AHIMA.org.
AHIMA-accredited courses are one option, but there are other schools, programs or boot camps to consider.
"We actually have three programs. All of them are designed to prepare students for entry-level opportunities as they start a career in medical billing and coding," explained Mark Gunther, director of consumer learning solutions at New Horizons Computer Learning Centers.
The programs vary in length from six months to 10 months, and students attend training four hours a day, four days a week. While too soon to judge their success rate (they've just launched the program in April), Gunther points to New Horizons' more than 20 years of experience and success in IT training. And speaking of experience, he claims they have the "no experience" problem licked for new grads.
"We have a plan to address the catch-22," said Gunther, explaining how their IT training program formula was applied to the development of their billing and coding programs.
"Three years ago we faced a similar dilemma in the IT space. We had students looking to fill entry-level positions such as help desk technicians or technical support specialists. They were faced with the same catch-22, because they lacked the hands-on experience," said Dave Sundstrom, vice president of business development. "Like our IT programs, the HIM program offers our students internship opportunities after the completion of their training. We've built the internship programs with local partners who need billers or coders [such as] local hospitals or doctor offices. Many students are going to need some real-life experience to put on that resume in addition to training," he explained.
For students wanting to become credentialed upon completion of the course, "We have targeted certification exams provided by the American Academy of Professional Coders (AAPC) and the National Healthcareer Association (NHA)," Sundstrom added. "We made sure the curriculum is preparing them not only for a career in billing and coding, but for professional certification as well."
For more on AAPC's Professional Medical Coding Curriculum, visit www.AAPC.com. Visit NHA at www.medicalcodingandbilling.com.
Not Set in Stone
And on the employer front, Nothom isn't convinced that there aren't other directors like her out there. In considering candidates new to the field, she offered, "I would weigh the interview process (how well they would fit with our needs and work environment) as well as the results of the coding test (how well did they do and what is their potential), not just their years of experience."
As with the lottery; however, you've got to play to win.
"My experience is that there are very few responses to the ads even when they are placed in professional publications aimed at those you are trying to hire," Nothom observed.
But the ads are there. ADVANCE's own career site at www.ADVANCEforCareers.com offers a keyword search feature allowing candidates to search for a job by state and region. There is also a free resume builder on the site that allows users to create and store resumes online. Or simply check local hospital Web sites, experts advise, as many facilities post their openings, instead of running a classified ad in the local paper.
Finally, keep the faith, say those in the field who have broken in. If it's any consolation, you're not alone. As discouraged as Perrin sounded, even she's not giving up. "I will sit for the CCS in September just to round out my credentials," she said. "I simply want to work as a professional coder, in a room with a stack of coding books and research materials to do the job correctly. I have the education, the interest in the matter at hand and the credentials." Now she needs the job.
Linda Gross is an associate editor at ADVANCE.
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