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We asked HIM professionals to tell us about their first day on the job, and they shared their stories.
Almost a decade ago I was winding down a career in makeup artistry. In my mind, I only had the general goal of working in health care administration. Essentially, I wanted to be someone's secretary. My experience was more aligned with purchaser and buyer positions in acquisition, so that was the first job for which I applied.
Instead of going into health care as a purchaser, I ended up pretty low on the totem pole: a file clerk. From there, things happened very swiftly: I moved to an administrative assistant, saw the opportunities in coding and sought certification. In essence, I was a home-grown coder (perhaps one of the last of that dying breed) who simply got into the trade by noticing what it took to be promoted and fulfilled those requirements.
Perhaps the most significant approach to my career has been my willingness to work in any setting for HIM. I took jobs based on the experience they'd give me, as opposed to the pay rate. That has benefitted me tremendously and allowed me to thrive across settings.
As for the education, oddly enough my formal HIM education did not really begin until after I was a certified coder. An HIM director who was not willing to hire me recommended I pursue formal education. I started my second venture into higher education in 2004. That school closed due to financial failure, and I was left with a cart of college credits, but no degree. For the past year and a half I've been in an online HIT program and anticipate graduating next December. The lesson for students here is that setbacks shouldn't prevent you from reaching professional goals. Also, education does not replace experience; both are integral to success, and you must pay your dues in both areas.
Kevin B. Shields, CCS, CPC, CCS-P, CPC-H, CPC-P, CCP-P, supervisor, HIM services, VA Medical Center
It is now almost 20 yrs ago when I first started. I was administrative secretary to new hospital administrator, in which I was unhappy. The request for med. transcriptionist position came across my desk, and I looked at that and said that famous sentence, "I can do that!" Very fortunate for me, I was probably one of the last in history to be trained on the job. The woman who trained me was VERY demanding as she needed to be. She taught me almost everything, except thecal sheath instead of fecal sheath. To my everlasting dismay, she didn't catch the error, and I later realized the mistake I was making, but only after making probably many of such errors.
Jacqueline Craig, transcriptionist, Baylor Garland Hospital
Garland, TX
First day on job was required to type death summary on friend of the boss. It was quite an emotional time and I gave the patient the diagnosis of "myocardial infraction" rather than myocardial infarction. This was back in the 1960s and everything had to be retyped--no "white-out" on death summaries.
M. Dormish, MT, Home
Goldsboro, NC
My first hospital job I worked primarily evening shift. We only had 4 work stations and some were shared by 2 and even 3 people. On evening shift if you didn't get your cafeteria food early, you went without, because the cafeteria was closed by the time you got a lunch break. One night I got a piece of chocolate pie that had particularly sticky fake meringue on it. I tried to keep it away from the computer keyboard, but we really didn't have anyplace else but the desk to put food, and I managed to get it all over my fingers. I cleaned it up thoroughly (I thought) and left for the night. The next afternoon when I came in, all of the transcription staff made a mass exit--I assumed they had decided to take a break together. Nope. The lady who primarily used that workstation was all poised to shred me because when she came in that morning she found--a sticky keyboard! Somehow I managed to say the right words and apologized profusely and asked her to show me where the cleaning supplies were if I needed them again. She did, we made friends, end of story. However, when the others returned from their "break" they were a little miffed--they had expected to see fur and feathers all over the place and there weren't any. The lessons? 1) Any kind of food and keyboards do not belong on the same planet. 2) A soft word and an apology can make a big difference in the outcome.
And here's a lesson that is just about the opposite.
I met with my department director one day in her office--nothing very important, I can't even remember the subject matter. Within a half hour after I went back to my workstation, the director called in another transcriptionist--we'll call her Jane---and ripped her up one side and down the other for something she had done. Jane put 2 and 2 together and unilaterally decided that I had gone to the director and caused this problem for her, and she refused to speak to me. As in, for weeks and months! And we worked the same shift, of course. It got a little awkward, but I bided my time and didn't make a fuss about it. When I left for a better job, the department director and transcription supervisor came in and brought cake and punch, and we all stood around making small talk, and I took the opportunity to look Jane in the face and ask her a direct question--she had to choose whether to answer me in front of the bosses, or ignore me. She hemmed and hawed and finally answered me. No one ever told the bosses what was going on, but the other transcriptionists had a tough time hiding their grins. A small victory, but worth waiting for. The lesson? Good things sometimes DO come to those who patiently wait.
Carol L. Matthews
I wasn't even out of my trade school when I got hired on with my company. I had already gone through the coding courses at school and thought that I knew enough to start in a position coding. Not so much. I knew how to get around in the books but had no idea how to read the reports. The lady that trained me was great. She had the patients of a saint. If it wasn't for her then I would have never coded again. She took me under her wing and let me ask questions even if I asked them time and time again. I went on and got my CPC certification and am now thinking about expanding my education. Never think that you don't know enough or be afraid to ask questions. That is the only way that you are going to learn.
Theresa Moss, Coder
Fort Collins, CO
It has been a long time since I was a student and my start was not like what happens now. I was already working as a training coder here at the hospital when I decided I wanted to get my RHIT. I had a 4-year college degree behind me already. At that time the only RHIT training was with AHIMA as a course through the mail. Four of us in the office started it, but only two finished 3 years later. The biggest problem was mailing in tests. You never knew what you got right or wrong and had to start the next module without knowing how you did on the previous test. Sometimes we had to wait a week or more to get the next lessons in the mail. It was not a very good system. I have tried one online course since then and it was much better. I just want to tell new students to stick in there. Studies and training when you are new sometimes seems never ending, but the truth is learning is never ending and shouldn't be. The constant change in this industry is what keeps my job interesting.
Gloria Barker
Coder, Western Missouri Medical Center
Warrensburg, MO
As most everyone knows, there is indeed a shortage of professionals in coding and HIM, but the shortage is only for experienced coders and HIM professionals . and the jobs are available but only for the ones whom employers actually want .the experienced ones. And of course, the majority of employers are not willing to train inexperienced students, hence the notorious catch-22 for students finding a job. What a lot of new students who are struggling today may not know is that there was really and truly a time when health care providers were more willing to provide training and mentoring to new students. Here is one scenario that happened to me early on that helped me to realize this.
I was volunteering at a local hospital doing filing and other basic HIM functions and spending a few hours of my time there studying hospital records that had already been coded. The HIM and coding staff were very accommodating to me to grant me this opportunity and generally were available to answer the questions that I had. However,as I ran into more and more questions, I ended up catching the coding manager and a coder at bad times when they were not available to answer my questions.
One day I casually asked the coding manager about how she started out and she explained that she had been personally trained and mentored by previous person who had her position. I remember feeling very disheartened when I considered that the very coding manager who had been reluctant to take some time to help me with questions about coding told me that she was personally trained and mentored by someone in her very first job. I found it hard to understand why she could not provide me with the same attention that she got when she first started out and why the person who mentored her was able to find the time to do so. I did not know a lot that I know now, but what I ended up doing to cope in the meantime was to start to write down my questions and trying to first of all research them on my own and then spread them a few of my most critical/pressing questions out over a number of people instead of just one or two coders. I reached out to several coders as well as to other coding discussion groups and listservs.
However, I want to share what I recently became aware of to explain what seemed an unfair situation to me in regards to the coding manager having a personal mentor/trainer. Within the last 20 -30 years, there has been a shift in the way that medical coding and billing is being done.
Years ago, it was not nearly as complex as it is today and the complex reimbursement methodologies that are in place today were not in place 20+ years ago. Hospitals, for example, were paid on cost and coding was not done for reimbursement, but for statistics purposes primarily. This was because the hospitals were reimbursed on a cost basis.whatever the hospital charged, Medicare and the insurance companies paid for it with little question. But with the advent of Medicare's complex prospective payment systems such as DRGs in 1984 and APCs in 2001, the pressure for hospitals to quickly and accurately code their procedures sharply increased. Hospitals could no longer be satisfied that their reimbursement would come, they had to make sure that they coded each account correctly because reimbursement was now directly dependent on the codes that they submitted to Medicare and the other insurers who later followed suit. They also had to ensure that the accounts were coded quickly because the reimbursement that they received was more limited than it had been and thus, the little reimbursement that they did get needed to come quickly in order to stay afloat as a business. Therefore, that poor coding manager was already overwhelmed with trying to do her own job and keep the charts going whereas the person who trained her likely did not have such pressures.
Christina Benjamin, MA, RHIA, CCS, CCS-P, independing coding and education consultant
We also asked readers to share their favorite go-to books and references.
One of the smartest things I did was pick up a copy of The Medical Phrase Index by Jean A Lorenzini and Laura Lorenzini Ley. I don't know what edition my copy was, as the front pages have long since disintegrated, but I bought it in early 1988. I was learning on the job in a multi-specialty clinic and that book was a tremendous help to me. I used it for 10 years and then when I went to work for a single specialty clinic, I gave it to someone just starting out. However, today I was looking on Amazon to confirm the author's names, and there is a very recent edition of the book out now so I ordered a new one. Some of the earlier used copies can be found on Amazon for less than 10 dollars, and it is money well spent.
There are two other books I won't be without--Dorland's medical Speller, Second Edition published by Saunders/Elsevier and Saunders Pharmaceutical Word Book 2008. Anything I can't find in those two books, I look up on Google, and when I find what I'm looking for I write the term in the Speller. I used to spend a minimum of $300 on new references every year, and had a book for every specialty that was available. But with these three books and the internet, now I only spend buy a new Pharmaceutical Word Book every 2 or 3 years. I like this drug book because it has street drugs, experimental and orphan drug listings, so that a new book is not necessary every year.
Carol Matthews, MT
I recommend the new hospital coder have a copy of 2 resources by Channel Publishing .1-the Expanded Table of Drugs and Chemicals: this resources saves the student coder many hours of researching the classifications of medications when they have to assign an E code for adverse effect or poisoning. This resource can also double as a source for help to the know the type of classification of a drug when assigning other drug-related codes such as the long-term use codes or the abuse of drugs codes or in other situations where the student needs to have an idea of the classification of a drug so that they can know what it might be treating.
The second resource I recommend for students is CliNotes by Channel Publishing. About a year or 2 ago, I had a coder who was prepareing for the CCS ask me for a list of the following items: 1) commonly used drugs and what diseases they are commonly prescribed for, 2) lab tests that are ordered to dx common diseases, 3) diseases with common symptoms. The answer I give to anyone who asks me that now is CliNotes because this textbook has the following features: There is a table on a single dedicated page for each main diagnosis in ICD-9 with the definition of the condition, the etiology of the condition, the signs and symptoms, the typical treatments, the medications and the diagnostic lab tests that are specifically associated with that condition. Excellent reference!
As an alternative, if you can't get that resource, just get the Educational annotation of ICD-9 for your standard ICD-9 coding book from Channel Publishing. Channel's ICD-9 book has the official coding, independing coding and education consultant guidelines, medical definitions and illustrations, A&P reviews, CC/MCC designations, etc. virtually eliminating the need for the medical dictionary.
Christina Benjamin, MA, RHIA, CCS, CCS-P
Tell Us Your Story!
ADVANCE is seeking stories about your experiences in HIM. Share what you learned with students who'll be reading our Student Center. Did you have an awkward first day on the job? What are some things you wish you knew way back when? What would you have done differently in your HIM career? We want to hear from you, so share your stories on these topics or anything else of interest to HIM professionals. Send your stories to cmcevoy@advanceweb.com. We look forward to reading your stories!
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