# The Hospital Coding Candidate



## ErikAZ (Dec 20, 2015)

I obtained my CPC-A back in 2004 and have worked my way over 11 years to a management job in a hospital in HIMS/Coding/CDI.  I served last year as the Education Officer for my local AAPC chapter and heard a lot of the same question over and over again... "How can I get a remote job in a hospital?".  I thought it might help to post some information about the last three coders I've hired in my department and their experience beforehand to give people an idea of what hospital coding managers are looking for.  I will also post my own "accidental coder" story. I know there are a few other hospital coding managers who post here as well and hopefully they'll be able to add to this thread.

1. "Coder A".   He is our newest hire and has been with us a little over a year now.  He is a CPC and a CCC who knows cardiology.  I know he started about ten years ago in coding and had worked for a small billing company learning coding for his first job, I know he did a few years cardiology coding for a large cardiology practice and I know he worked elsewhere for a while.  Before hiring him he had no hospital experience but he had networking.  He was very active in his local chapter and I'd actually met him before at an officers meeting although I didn't realize it when I contacted him about the job.  A friend of mine (and coder) from a previous job had recommended him when we lost our cardiology/IR expert to another hospital.  He codes strictly cardiology and outpatient charts although we will eventually be teaching him inpatient coding.  

2.  "Coder B".  She is an ED coder.  She had no coding experience at all but did an RHIT practicum in our HIMS department and was so sensational we knew we wanted her.  It took nine months after she left during which time she managed to get a job in our hospital in another department before we had an opening.  Then we hired her and began the process of training.  Now a few years in she's a rock star.

3.  "Coder C".  She is a CPC and worked for an orthopedic hospital in Phoenix.  She had experience doing ortho surgeries and knew some inpatient coding so she had a good skillset.  She's a super valued member of our team and like Coder A I believe started out in billing.  I think she probably has 12-15 years total coding experience.

4.  The "Accidental Coder" story.  For reference I was a truck driver who was hurt.  A year of school and my first "coding job" was after getting my CPC-A.  I had called the local community college (RHIT program) to ask about hospital coding classes and on a hunch asked the lady "how do you find your first job" (just before she hung up).  She said "Well actually someone posted something on our board today" and she gave me a name and number.  I called a lady who was coding for a small billing company (just dx coding superbills) and they hired me.  My first paycheck bounced.  Sometimes we went weeks without being paid.  It was an ordeal but honestly I'd have worked for free for the experience.  After about a year that same lady called me up, asked me "are still there?".  I was and she told me about a contract ED coding job at a large hospital.  I had no experience but I could learn.  It was just a nine month temp job but the pay was twice the other job and my checks didn't bounce.  After that it was three years coding MRI, CT and Mammograms at a radiology office, then three years at AZ Heart as an EM Auditor/Educator, then they started with layoffs.  I went back to my original school where I'd taken my one year CPC program and the teacher told me about this new hospital looking for someone.  Then the next day a recruiter called me about the same job.  He had gotten my name from a peer.  It's four miles from my house.  I was hired as a "concurrent coder" and worked my way up to Lead Coder and worked for four years before leaving for a promotion (Inpatient Manager for a three hospital network).  After a year we merged and not wanting a 40 miles drive to work I returned to the hospital by my house and I'm still there.  Now #2 in our HIM Department I don't plan on leaving.  Along the way I obtained other credentials in coding and CDI and I'm about a year from my RHIA so the education never ends.  

Some things I've learned:

1.  Most hospitals want CCS or at least CCA credentialed coders.  Some like Mayo require their coders to have the RHIT.  Still there is room for a CPC in some locations with a unique skillset.  That three hospital network I went to wouldn't hire a non-AHIMA coder but I've hired two CPCs because they had advanced skills (Cardiology and Ortho/Inpatient).  That doesn't mean run out and get a bunch of specialty credentials (unless it's the CIRCC).  Some hospitals will hire CPCs but be aware hospital coding is very different.

2.  Networking is important.  Except for my job at Arizona Heart every coding job I've had was "told" to me by a coding peer.  I can't emphasize enough how important this is.  Even in a big city like Phoenix it's a very small community and you run into the same people over and over again.  One of my coders at that three hospital network was actually my supervisor at the radiology office I worked at!  

3.  Performance counts.  Our "Coder B" above had no experience and was a HIMS student yet was so sensational we all noticed her.  Get a job in a hospital doing something else and shine.  You have to be open to everything.  I had one of our business office people email me recently asking me if we had any openings.  I had to say "no".  He knew someone in our facility who was a new CPC and was job hunting.  Sometimes it won't work out but other times it will.

4.  Education.  Before I became a concurrent coder I'd never heard of DRGs (that's Diagnosis Related Groups).  If you're going to inpatient code you will live and breath DRGs and ICD-10-CM Volume 3 (that's the PCS hospital inpatient procedure codes).  I'd never heard of those either.  Be aware that hospital inpatient coding is an entirely different animal and look instead at things like ED or outpatient surgery when looking at hospital jobs.  "Hospital Coding" means several different things.

5.  Can you be taught?  Perhaps this is as important as experience.  The jobs I've had and the new coders I've hired shared the trait of "I don't really have experience but I can learn".  Easier said than done though as the only way to prove you can learn is to be observed which again is where networking comes in.  Our "Coder A" above had a very good reference from someone I trusted that overcame the "0" hospital experience factor and the lack of a hospital type coding certification. Your reputation is everything.

6.  Remote work.  All our coders work remotely. After hire they did 1-3 months in the office until they could show they were OK and could do the job then they are sent him.  They still come in occasionally if they have connection problems or they just want company.  One lives out of state so she rarely returns.  At that three hospital network I was at I had four or five out of state coders.  I myself would have trouble working from home full-time although I do 2-3 hours a day at home before going in.  For all this was their first remote position so with the exception of "Coder B" who is a "newbie" all the other coders had 5-10 years experience before securing a remote position.

Primer for a hospital job:

- Be open to taking a non-coding job initially.

- Consider obtaining the CCA certification and working toward the CCS.  Most hospital managers are RHIA and RHIT credentialed (at least Directors) and the CCS is what they're familiar with.  

- Network and join your local state association (both AAPC and AHIMA).

- Attend coding roundtables put on by your state associations.  Ours have some great ones and even if it's on inpatient coding and you don't understand it you can sit and listen and take notes.

- Learn about MS-DRGs (and APR-DRGs if your state Medicaid uses them).  

Also a possibility:

If you have a clinical background (specifically a nurse) you might want to look into CDI (Clinical Documentation Improvement).  I will tell you this is a huge focus in hospitals now and the "big thing".  I did CDI concurrently with coding and can say a coder who knows DRGs who can do CDI (understand documentation requirements) is golden.  My personal belief is coders are just as good as an RN at CDI (I'm biased) because they understand the documentation need to support medical necessity and thus a DRG assignment.

Don't be opposed to billing:

When I worked that first job for that little billing company I learned to also do aging and how to file claims.  At the radiology office and AZ Heart I worked closely with billers on coding issues.  Now in a hospital I'm on a couple panels (revenue cycle/utilization review/denials).  Knowing the process of the revenue cycle and how claims are processed is a great benefit in a hospital.  It's something all our coders understand.  Don't frown on a billing job opportunity if one comes up.

The future:

Yes ICD-10 has slowed productivity for hospital coders and has increased demand.  I and all my coders field weekly emails and phone calls from recruiters.  Again though they all want experience.  The challenge is to find that "first chance".

Summary:

I'm sorry this is so long winded but I started typing and didn't stop.  I hope some of this is helpful and hope other hospital coding managers who post here will chime in with additional information.  Hospital coding is a great career but it is NOT easy to break into and it's important to know things a manager is looking for.  Be open to non-coding jobs at first, learn billing and the revenue cycle, educate yourself on DRGs and ICD-10 Volume 3 and network.  

Good luck and feel free to ask questions I will do my best to answer them.  You've worked hard for your CPC credential but getting it was just the beginning of the journey.

Erik


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## Pam Brooks (Dec 21, 2015)

Truthfully, I shudder when I hear a new hire telling me that their ultimate goal is to be a remote coder.  I have found it extremely difficult, between IS problems, lack of communication, training challenges and schedules to manage remote coders in a way that allows them the random flexibility and huge wages that everyone seems to want. Remote jobs are (in my opinion) for the top-shelf coders, who can work exclusively on an independent basis and who communicate effectively through electronic means.  Also, when a new coder interviews with me, I want to know that they are prepared to be with me for the long haul, before I invest time and resources into training them for an eventual remote position (which I currently have very few).  It's like going out on the first date and telling them that you can't wait to get married and have six kids.


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## acoder2014 (Dec 25, 2015)

Thank you for posting this. I currently have a CPC-A and have the opportunity for an ED auditor/coder position. My career path is to obtain a CCS and do inpatient coding. I'm unsure whether ED coding would limit opportunities to transition to IP coding, or whether I should focus on getting an outpatient coding position. This particular facility has an ed audit/coder position, and a separate outpatient coding position. Any advice is greatly appreciated.


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## ErikAZ (Dec 28, 2015)

acoder2014 said:


> Thank you for posting this. I currently have a CPC-A and have the opportunity for an ED auditor/coder position. My career path is to obtain a CCS and do inpatient coding. I'm unsure whether ED coding would limit opportunities to transition to IP coding, or whether I should focus on getting an outpatient coding position. This particular facility has an ed audit/coder position, and a separate outpatient coding position. Any advice is greatly appreciated.



I would absolutely say it does NOT limit your opportunities.  Just getting in the door with an ED/Auditor position would be great or the outpatient position.  It's much easier to transition to another "type" of coding in the facility if you already do one type (note my first hospital experience was ED coding).  Just getting it on the resume is a huge deal so I'd say take whichever one appeals to you at this time.  From a practical standpoint if you were outpatient coding you would have more opportunity to read actual charts (versus short ED notes) for things like overnight observation surgery visits and such.  Longer term the outpatient might put you in a better practical (experience) position but again either position is getting your foot in the door.  Go for it!

ErikAZ


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## JEYCPC (Dec 28, 2015)

Thank you Erik.  I found your post very educational.


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