# Went through an externship, still no one wants me



## gingerm.clark (Mar 21, 2014)

Does ANYONE know of any positions that are open?? I have my CPC-A. I've done an externship (but they weren't able to hire at the end of my externship so I had to move on). I'm ICD-10 certified. I took the AAPC's online coding curriculum and I'm a member of AAPC. However I didn't go through an "accredited" college curriculum. I was trained by an AAPC "accredited" instructor though!! And she taught at an "accredited" college with an "accredited" curriculum and taught me the exact same material that she was teaching at the school. Shouldn't that count??! I don't know what more these people want from me. I don't have the money to take a $15,000 "accredited" program! I got my CPC-A back in October 2013 and I have yet to earn 1 cent back on all the money I've plunked down to earn these certifications. I'm just so desperate at this point; I don't know what I'm going to do. Can anyone PLEASE point me in the direction of someone that would hire me? I can't bear to go back to a waitress position after trying SO hard to prove that I'm intelligent and worthy of a well-paying job. I live in the east side of Dallas, TX, if you know of anything around there and I'm willing to travel a good distance.


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## MsGarner69 (Mar 21, 2014)

Have you tried looking into any medical office work? You might have to start off in billing, charge entry, registration, filing etc...to get your foot in the door to gain more experience. Just because an instructor is "accredited" from an "accredited" institution doesn't equate to you having the experience that's often required to get in the coding industry. They care about your experience more so then the credentials of your instructor or where they taught. And hiring managers don't simply choose their candidates based on the fact they deserve great pay..its not that simple with ANY career. 

That externship you did is valuable, don't minimize that. But you're going to have to continue taking baby steps to get to the big picture. What do you do to network with others in the field? That's very valuable and highly necessary also. This is a very hard industry to break into and often it's not going to happen overnight, that's why you need to have back up plan(s) when you see that getting into coding right away is not happening for you, explore other ways to gain the knowledge necessary to eventually get there. Start off in another area, then work your way up. 

I'm a recent graduate of an Inpatient/Outpatient Medical Billing and Coding program and I haven't even sat for my certification yet and let me tell you, after reading the abundance of posts on this forum regarding EVERYTHING that is required of us (take a long hard look around this forum to understand what I'm saying) I feel its going to be to my benefit to start from the ground THEN work my way into a coding position. Because from what I've been seeing, we didn't learn everything we need to know in an in depth fashion and I don't want to get a position that's requiring me to have knowledge of certain areas that I don't already possess. I would rather grow into the position then take it blindly wasting my time along with the company's...unless the position is _solely_ entry level. 

The bottom line is to not give up. You've spent time and you've spent money. Why let that go to waste? Turn the negatives into some positives. You owe it to yourself to do that.


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## Bready (Mar 22, 2014)

Dear Ginger,
Garner gave you very good advice. The foot in the door is the place to start. I live in Dallas too.  If you are only physician certified, you will have a more difficult time getting to be a coder w/o experience so you must be willing to start somewhere else like receptionist or file clerk or whatever.  You could also look at the hospitals for Coder 1 positions.  Parkland or Childrens or UTSouthwestern  or Baylor are always hiring--keep looking on their websites and  applying. Since you are willing to travel--look at Plano, Arlington, Irving as I see jobs listed in those areas. You may have to start out as an account rep or unit secretary at one of the hospitals but once you get IN you are allowed to apply for other in-house positions(after 1 year). In-house employees get first preference over outside applicants.  Competition is stiff but try and be patient. Also, do not "overprice" yourself.  When you get an interview, tell them the chance to work and grow with their company is worth the sacrifice of a few dollars.  Salesmanship and an upbeat and eager attitude will win the day!
Good luck.


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## akj (Mar 22, 2014)

I work in a hospital HIM department with several other CPC's.  Not one of us went through a 'accredited' college curiculum in coding.   However, every single one of us started out in an entry level position (such as file clerk, registration clerk, medical record clerk, secretary), working our way up through the system to get where we are today. For some it took a couple years, some of us quite a bit longer.  

I think it is unfortunate that some educators lead their students to believe if they take this or that curriculum or program, they will get a coding job out of the gate.  I'm sure this can happen, but I doubt it is the norm.

I know many aren't keen on this idea, but I actually volunteered at the hospital I now work at, it got me in the door and gave the people that hired me an idea of my work ethic, as well as personality. 

I wish you all the luck and happiness in your new endevors.  Don't give up!


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## Saedron (Mar 23, 2014)

I have to agree with everyone here. A certification is not a guarantee of employment no matter what the web ads promise. Coding is MUCH more than smacking a number on a documented encounter. It's more about coaching providers on the correct way to document, answering pressing questions about coverage from providers, fixing provider coding mistakes, and understanding what can be done and when and how you can bend the guidelines. That ONLY comes with experience. When asked, "Well, why not?" by a provider you better know the answer and you better know it yesterday. Are you ready for that?

Having said that, I will also agree the front door is the place to start. That is where I am now. I got a job at the front desk just to get in. I then transitioned to a referral position where I learned just how off these providers can be. I have to 'code' the referrals to justify the procedure. Providers are not coders. We speak different languages. The coding world is more black and white and providers are totally focused on patient care. Merging those two worlds is a coder's job. Explaining and educating is a coder's job. 

I had my first interview for a Coder I last week after almost two years of being rejected on lack of experience. I was lucky to get the interview. I think it went well. In my heart, I'm scared to death! If I get this job I will have seven providers to answer to. The emails will be flying about can I do this, why can't I do that, I forgot to sign a note, is this incident-to, can I bill two visits, what is the criteria for a TCM code, I didn't get an ABN, what is modifier 25....and the list goes on. 

Get in the front door. Read. Read more. Know your MAC. Be patient and stack your resume. Don't give up


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## MsGarner69 (Mar 23, 2014)

Saedron said:


> It's more about coaching providers on the correct way to document, answering pressing questions about coverage from providers, fixing provider coding mistakes, and understanding what can be done *and when and how you can bend the guidelines.*



Hello Saedron,
Could you please elaborate on what I have in bold above so I won't misunderstand what you actually meant by that last statement?


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## memebelle2000 (Mar 23, 2014)

*Keep trying!!!!*

 
Ginger, for the most part everyone is right. I've been working for a surgeon for about 2 years in July and he believes in company education, etc in which he funded my AAPC course so that was pressure within itself. Secondly, I didn't passed the CPC on my first try it was actually my second. Soooo as of April 15, 2014, I have my CPC-A. Anyway, I'm his Medical Receptionist, Marketing Administrator, Proofreader of his progress notes, I prepare H & Ps for surgery, amongst other duties; needless to say I've worked my butt off. So this week I will be training with the Office Manager to coder b/c she's certified as well. Please be patient and don't give up!!!!! No matter what anyone says..... Working at a physicians office is more intimate, you will learn a lot as well as how to handle doctors, how to present certain issues, etc. I've worked for 2 surgeons but right now it's 1 and he's a perfectionist and analytical. This is an excellent environment to be in!!!! I also have participated in minor office surgeries. I'm saying all of this to say it is hard work, but all of this will not only help me better understand coding concepts, but why and how he does what he does. Just pray and keep searching.





gingerm.clark said:


> Does ANYONE know of any positions that are open?? I have my CPC-A. I've done an externship (but they weren't able to hire at the end of my externship so I had to move on). I'm ICD-10 certified. I took the AAPC's online coding curriculum and I'm a member of AAPC. However I didn't go through an "accredited" college curriculum. I was trained by an AAPC "accredited" instructor though!! And she taught at an "accredited" college with an "accredited" curriculum and taught me the exact same material that she was teaching at the school. Shouldn't that count??! I don't know what more these people want from me. I don't have the money to take a $15,000 "accredited" program! I got my CPC-A back in October 2013 and I have yet to earn 1 cent back on all the money I've plunked down to earn these certifications. I'm just so desperate at this point; I don't know what I'm going to do. Can anyone PLEASE point me in the direction of someone that would hire me? I can't bear to go back to a waitress position after trying SO hard to prove that I'm intelligent and worthy of a well-paying job. I live in the east side of Dallas, TX, if you know of anything around there and I'm willing to travel a good distance.


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## Pam Brooks (Mar 24, 2014)

MsGarner69 said:


> Hello Saedron,
> Could you please elaborate on what I have in bold above so I won't misunderstand what you actually meant by that last statement?


 
I think what she's saying is that there are a lot of "gray" areas in coding, particularly in E&M.  And payers have different criteria as well.  I don't think Saedron's suggesting for one minute that you bend the concrete rules, but as a coder who's been doing this for a really long time, there are a lot of considerations that aren't crystal clear.  A good coder knows where you have to be spot-on and where you have flexibility.  New coders often get caught up in bullet-counting and minute details that are both unrealistic and unnecessary and cause too much aggrivation for providers (another new-coder mistake).


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## MsGarner69 (Mar 24, 2014)

Pam Brooks said:


> I think what she's saying is that there are a lot of "gray" areas in coding, particularly in E&M.  And payers have different criteria as well.  I don't think Saedron's suggesting for one minute that you bend the concrete rules, but as a coder who's been doing this for a really long time, there are a lot of considerations that aren't crystal clear.  A good coder knows where you have to be spot-on and where you have flexibility.  New coders often get caught up in bullet-counting and minute details that are both unrealistic and unnecessary and cause too much aggrivation for providers (another new-coder mistake).



Good Morning Ms. Brooks, 
Thanks for clarifying, I was hoping she wasn't meaning it the way I was taking it because for a second I was looking like .  And yes, I've experienced (just from my schooling) that E and M coding is not crystal clear. The way we are taught is through the bullet method and I always felt that was a bit tedious to say the least. I figured it had to be another way once we got into real world coding to find the correct code without going through all those bullets to get there but still prepared myself to do it IF that was the only way possible. I've yet to understand why we are taught that method if realistically we wont be coding like that at all on the job. I understand knowing how the 95-97 guidelines work but you would think that too constantly "hammer" that technique into our heads would hinder us on the job.


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## Pam Brooks (Mar 24, 2014)

MsGarner69 said:


> Good Morning Ms. Brooks,
> Thanks for clarifying, I was hoping she wasn't meaning it the way I was taking it because for a second I was looking like . And yes, I've experienced (just from my schooling) that E and M coding is not crystal clear. The way we are taught is through the bullet method and I always felt that was a bit tedious to say the least. I figured it had to be another way once we got into real world coding to find the correct code without going through all those bullets to get there but still prepared myself to do it IF that was the only way possible. I've yet to understand why we are taught that method if realistically we wont be coding like that at all on the job. I understand knowing how the 95-97 guidelines work but you would think that too constantly "hammer" that technique into our heads would hinder us on the job.


 
You do have to 'count' bullets....but not necessarily every single one that's selected---only those that are relevant to the chief complaint(s). Documentation in an EHR where providers can get 'click happy' is one of those situations where coders have to think outside the box and focus on the nature of the presenting problem rather than the volume of documentation. Just because an 8 OS exam is performed, doesn't always make that exam medically necessary. The 95 and 97 guidelines offer a lot of great examples and are the model used by the vast majority of payers, and of course CMS, but not every scenario is explained in detail. 

Auditors in this field tend to understand that each one of us interpret things a little bit differently, and if we can confidently support our rationale, we typically accept our professional differences of opinion and value those differences. Unless someone is blatantly incorrect, or has acted irresponsibly, I tend to believe that most coders have either mis-communicated, are inexperienced, or were trained incorrectly.


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## lorrpb (Mar 24, 2014)

>>I've yet to understand why we are taught that method if realistically we wont be coding like that at all on the job.

I would like to respond to this as an educator and coding textbook author. Instructors and textbooks must present the "official" guidelines, information, and techniques. We try to give an idea when things are done differently in the workplace, but there are so many variations, it is impossible to cover all of them. Things vary from one region of the country to another, and from one specialty to another. This is true in many fields, even ones you might think are cut and dried, such as medicine or nursing.

Also understand that not every instructor has worked in, or is an expert in, every area of coding. Someone may have tons of experience in an orthopedic surgery coding, but that doesn't mean she knows about cardiology, or primary care, or even E/M coding. 

I tell my students that I have not used every code in every coding manual and I sometimes come upon scenarios or exercises that I haven't personally coded before. I can't answer every question off the top of my head, I often need to research and look things up. That's just reality.

Our job as instructors is to teach you the official guidelines and the correct or most generally accepted way of doing things. It is usually challenging enough for all students to master this information, it just adds to confusion when we start talking about all the variations. Again, this is true in any field, not just coding. I hope this helps give some perspective.


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## Saedron (Mar 24, 2014)

MsGarner69 said:


> Hello Saedron,
> Could you please elaborate on what I have in bold above so I won't misunderstand what you actually meant by that last statement?



Just learning to look at things a different way MsGardner. For example, the PFSH element. I always looked for it in the chart where it should be....under the PFSH. But I can actually give credit for the element if the PFSH is listed under say the documented chronic condition in the explanation of the condition (i.e. HTN well controlled, patient understands necessity of compliance with medication as father and brother both had chronic uncontrolled HTN) Something along those lines.

Maybe 'bend' was the wrong word to be sure. But my point was things like this come with experience.


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## dclark7 (Mar 25, 2014)

Please try to see this from the doctors' point of view, this is his/her livelihood. Doctors have families they need to support and employees they need to pay. The recent atmosphere for doctors can be quite scary, they have CMS and the OIG breathing down their necks screaming "FRAUD" at every turn (at least that's what is seems like to them); they have constantly changing regulations to keep up with and reductions in payments. They have EMR, EHR, HIPAA, ACA and ICD-10 all coming at them. If you were in their position would you want an inexperienced person in charge of your paycheck?

There are a lot of nuances in coding, knowing which insurance company wants you use modifier 50, which one wants RT/LT, who wants 25 on an E/M with fracture care and who wants 57. Not all of these equate to correct coding, but "the guy who pays the bills makes the rules" is quite evident in the medical field. You do what the insurance company wants you to do as long as it still accurately reflects the work done. You need to know when to go along with an insurance company request and when you need to fight it to make changes in their policies. New coders don't have this knowledge yet, so doctors are going to hire experienced ones. Is it fair? No, but it is life and when you see it from their perspective it makes very good business sense.


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## bowenl67 (Mar 25, 2014)

I'm so glad I've been able to read everyone's replies to Ginger's post regarding frustration getting a coding job....because I'm in the same boat!! I've been so discouraged lately. I did not take my medical coding course through an accredited college as well but from a private instructor that taught medical coding at a college previously. I passed my exam May 2013 and I've been trying to find a job since then. I've applied for several coding jobs as well as a entry level Coding position. I did get an interview but did not get the job  Recently I've been taking the ICD-10 course; completed it just last Saturday. Now I need to take the exam to be certified. It's been discouraging all the money I've put into this and have had no luck landing a job. But I feel a bit more optimist after reading everyone's comments. I'm going to try other avenues to get experience and build that resume!!! 
Thank you everyone!!


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## Saedron (Mar 27, 2014)

Well, I got the job! Just in case anyone was wondering. Ginger, don't give up!!


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## maddismom (Mar 27, 2014)

Congrats!


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## kalyeope (Mar 29, 2014)

Keep trying.  I was very lucky to get a job soon after I was certified but it took me 250 resumes and a lot of time and tears.  I went to an Apple one for medical staff and she told me there wasn't anyone that was going to even talk to me let alone hire me even though my tests were spot on, I was certified and have a degree.  I simply had no real world experience.  I went home defeated and depressed and was ready to start looking for work at Carls Jr. 


And then it happened...

The same woman called me two days later and told me she had someone who wanted to interview me.  I jumped on it and they hired me on the spot after giving me their own test which I didn't pass but she said I knew where to look and had all of the concepts down and she would rather train someone without a lot of bad habits. 

I made more as a waitress than I did at my first coding job but that was all it took to get me in the door.  Three years later Im at a really big company with no where to go but up, I get to start remotely from home next month and I have headhunters calling every month to talk to me.  I couldn't even imagine how much I would learn or where I would be.  I love my job even with all of its frustrations.  

The moral of my story.  Never give up because you never know where your chance will come from or when and when, you will appreciate it more and you will look back and it will all have been worth it.


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