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The career progression ladder for clinical coding professionals was developed by the American Health Information Management Association (AHIMA) and published in the April 2002 Journal of AHIMA. When I saw this article, I knew that I was on one of the rungs to the top. It might take me quite a number of years (maybe even until retirement, which is not that far away) to get there, but I can be a very stubborn individual.

I am actually halfway to the top and it only took me 10 years to get here. However, I am now tethering on this ladder and wonder why I want to go on to bigger and better things when I have already accomplished so much in a relatively short period of time. This type of rationalization seems to be the "nature of the beast" in the health information management (HIM) profession. Nothing ever stays the same. New technology and advancements in the profession keep us on our toes. We have to stay in shape to progress to higher levels.

The following are steps on this career progression ladder:

Level One: Certified Coding Associate  (CCA) credential or on-the-job experience
Level Two: CCA or training combined with job experience
Level Three: Certified Coding Specialist (CCS) and/or CCS-P (physician-based) credential
Level Four: Registered Health Information Technician (RHIT) credential plus CCS or CCS-P
Level Five: RHIT plus CCS or CCS-P with added qualifications
Level Six: Registered Health Information Administrator (RHIA) credential plus CCS or CCS-P
Level Seven: RHIA plus CCS or CCS-P with added qualifications
Level Eight: RHIA plus CCS or CCS-P with master's degree
Level Nine: RHIA plus CCS or CCS-P with master's degree and added qualifications
Level Ten: RHIA plus CCS or CCS-P credentials with doctorate degree

The ADVANCE 2002 salary survey results indicate that the pay scale goes up according to credential and/or education level. Of course, this is an incentive to work our way up the ladder, but you may reach a point where salary isn't a top priority.

Typically, we start off that way but we encounter other obstacles on our climb. For most, family obligations seems to interfere with our career goals. Some HIM professionals start early and achieve success before starting a family. Others, like myself, start a family and then strive to catch up with those who have been working and advancing for many years. We can all learn from each other. Many students receive credit for life experiences. It is amazing how many people with diverse backgrounds make their way into the HIM profession.

As a coding instructor in the health information technology (HIT) program at Delgado Community College in New Orleans, LA, students frequently tell me that they want to be a coder. To them, a coder is someone who makes a lot more money right out of school. Of course we all know someone who is lucky enough to have landed that great job right after graduation. However, I can tell you that I sure didn't find it right away. I encourage students to take any job in an HIM department that is open in a type of facility that they would prefer to work at in order to get their foot in the door.

Once they have established themselves as a reliable employee who is willing to learn, they should be able to find openings for advancement. If not, they are gaining valuable experience because every job is important to getting the job done as a team.

The biggest problem encountered in advising students is how to tell someone that they may be better suited for work other than coding. What makes me the expert? Well, I am.

I can say that I am halfway up the ladder and they are at the bottom for one thing. I am also in touch with professionals who hire these coders to work at their facilities. I know what it takes to be a coder and what is expected on the job. Am I always right? No, I am certainly not.

However, I do see students who have an aptitude in other areas of HIM and try to encourage them to excel in those areas. Again, I emphasize that we are a team and need all of the players to get the job done.

Many individuals fail to realize that the coding ladder doesn't specifically address the fact that an RHIA/RHIT credential is proof of entry-level coding competency, and RHIA/RHITs do not need the CCA credential. AHIMA's new credential, the CCA, is an entry-level coding credential. Ideally, this credential was designed for coders who have completed a coding certificate program and have at least six months on-the-job experience.

The CCS and CCS-P was designed for expert coders with five years on-the-job experience. A combination of the RHIA or RHIT and CCS and/or CCS-P credentials enhances a coder's skills and moves them up the ladder.

All of this sounds simple enough, but you have to consider what it takes to get to the top. I have a great deal of respect for anyone who works and goes to school (myself included). As a new graduate of Delgado's HIT program in 1996, I attended the AHIMA National Convention in Orlando, FL. I also took my RHIT exam in Orlando and was on cloud nine. I knew without a doubt that I had passed (due to the fact that I was a good student and had spent countless hours preparing for the exam). I was ready to conquer the world. When I think back, I'm not sure if I thought things would be easier from that point on or if I was just relieved to have finally taken the exam and was looking forward to a break from my studies.

I attended a Student Forum at that convention that set the course for my HIM career. As a student, I was aware of the AHIMA Officers and the Specialty Society Chairs. To be able to hear them speak to a group of students about career advancement was like a dream come true. One person, Lenore Whelan, RHIA, CCS, CCS-P, encouraged me to become a coder. This really made a difference in my career goals. Before the forum, I was a little overwhelmed about how to apply all the newfound knowledge that I had acquired during my studies. I felt that I knew a little bit of information about a lot of areas in HIM but not enough to specialize in any area. My HIT Program Director, Robert Garrie, MS, RHIA, had implied that I may have an aptitude for coding. The problem was finding a job with no experience. One special person gave me a chance. That was all it took to get me on the coding ladder and I have not stopped climbing. Although as I mentioned earlier, I am tethering a little at this point.

I am 50 years old and can't remember what I wore to work yesterday. Yet, I am taking a course in an RHIT to RHIA progression program that requires me to remember up to 17 chapters in a course that I am taking in pathophysiology and pharmacology. Yet, in my heart, I know that I am learning so much and my skills are being enhanced. I may just need a short break.

Sometimes we just need to catch out breaths before we can continue climbing. There is also no doubt that the going gets slower as we age. Yet, experience keeps us from making as many mistakes along the way. Also, just airing my concerns seem to help me get focused and prepare to start a new semester. Also it is a consolation to know that no one in this profession knows it all -- which means that there really might not be a top to this ladder after all.

1. "Climbing the Coding Career Progression Ladder."  Journal of AHIMA, April 2002.
2. Advance for HIM 2002 Salary Survey Results.
3. CCA Candidate Handbook, AHIMA.
4. 2003 CCS/CCS-P Candidate Handbook, AHIMA.

Linda H. Donahue is the HIT Program Instructor at Delgado Community College, New Orleans, LA.


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I am recently relocated to Central Florida. I have a Master's Degree in organizational Management. My last 6 years in NH I worked for a HOme Health Agency as a Systems Support Manager. I managed a clerical dept. and was responsible for laptop training of all professional clinical staff.
My question is this. Is there a certificate program that would then allow me to take the RHIT exam? I have an extensive medical background and am not interested in starting over in a degree program.



Connie Bartosiewicz,  Systems Support Manager,  Home Health agencyMay 04, 2008
Florida, FL


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