Constructing a Career in Coding

By Susan Chapman for For The Record

For aspiring coders, landing that first position can be intimidating. But never fear, industry experts are here to offer advice.

Landing that all-important first job can seem daunting for a coder who is just entering the field. However, incorporating sound advice from seasoned experts can help job seekers find a position that can set them well on their way to success.

The Current Job Market

One factor that greatly influences employment prospects is the fluctuating job market. Currently, experts view the job climate somewhat differently.

“Right now, there is a shortage of medical coders. One reason is when the industry changed from ICD-9 to ICD-10, many of the older coders decided to retire rather than have to learn the new coding system,” says Cindy Edgerton, MHA, MEd, RHIA, director of the HIM program at Connecticut’s Charter Oak State College. “Another reason is that people just don’t know what medical coding is and that medical coding is a career option. It has been hard to inform the public about this career choice, so there are more jobs than there are trained and experienced coders. Many coding jobs are remote, so working from home after six to 12 months of experience is definitely a possibility. Most coders see this as a really good perk.”

Rachel Lynn Pratt, RHIT, CDIP, CCS, inpatient coding supervisor at University of Utah Health, does not believe employment opportunities for new coders are quite as promising. “For new coders, the current market isn’t very good unless you know someone in the field. More employers want coders with at least three to four years’ experience behind them,” she says. “With new coders, there is a higher likelihood that mistakes can be made, which then requires more resources. But if you’re experienced, you tend to make fewer mistakes and require fewer resources.”

Melanie Endicott, MBA/HCM, RHIA, CDIP, CHDA, CPHI, CCS, CCS-P, FAHIMA, an AHIMA-approved ICD-10-CM/PCS trainer and vice president of HIM practice excellence at AHIMA, agrees that the current job market favors experienced coders. “Employers need coders to be productive right away and they sometimes shy away from hiring inexperienced coders because they could take many months to train,” she says.

“It is a difficult job market,” acknowledges Angela Lehoux, BS, CCS, CDIP, CIC, COC, CPC-I, director of education at Libman Education. “The twin influences of offshoring and technology mean there are fewer jobs, and new coders are competing with displaced experienced coders for the positions available.”

On the other hand, Lehoux says because the opportunity to work remotely is a boon to job seekers, “the days of being limited to the opportunities offered by your local hospital are over,” she says.

Academic Path to Success

Experts advise aspiring coders to focus on obtaining the appropriate academic credentials. “The minimum is a medical coding certificate program, and an associate degree in health information management may be preferred by some employers,” Edgerton notes. “This degree from a CAHIIM [Commission on Accreditation for Health Informatics and Information Management Education]-accredited HIM program allows a graduate to sit for the RHIT exam. Many employers are looking for credentials such as RHIT, CCS, and CPC.”

Endicott says employers want to know whether candidates have taken college-level courses. “Specifically in anatomy and physiology, medical terminology, pathophysiology, pharmacology, and coding. The overall quality of education is important, too. There are many great coding certificate programs available that take less than a year, and that could be sufficient—it just depends on the rigor of the courses included in the curriculum. Some employers may be looking for a minimum of an associate degree for their coding professionals,” she says.

Pratt prefers candidates to have an associate degree in HIM with a bachelor’s in any field. “When I’m hiring a new coder, I look for a four-year degree. There are four coder levels, one through four. If you want to be a coder four and you want a good salary, you have to have a bachelor’s degree,” she says.

However, the courses a candidate takes when earning those degrees is not as important to Pratt. “I don’t think the mix of classes matters. The only things I look for are credentials, experience, and bachelor’s and/or associate degrees. If you already have an associate in HIM, I’m just looking for that four-year degree, and it can be in a completely different field,” she says.

Edgerton adds, “I don’t think employers really look at the mix of classes or class load because they know that everyone is on a different path with different life demands. But if a new graduate took a heavy class load while working and managing life and still did really well, she might want to emphasize that in an interview by emphasizing how it shows that she is a really hard worker with great organizational skills. This can start a conversation about goal setting, working toward goals, and how that skill will make for a great employee.”

Prevailing opinions hold that the mix of classes is unimportant. “Employers, in our experience, see academic training as only a starting point,” Lehoux says. “Most depend on a coding test as part of their interview to establish that the applicant has at least the basis of understanding the coding process. The employer knows that a new coder will need training and mentoring and that it will take time for him to be a productive and valuable part of the team.”

Building a Solid Résumé

A prospective employee’s résumé is the first step in catching the attention of recruiters and hiring managers. To stand out from the crowd, Edgerton advises job seekers to include key terms. “Many employers today are putting résumés through software that searches for key terms, and any résumé without terms they are looking for will not even make it to the HR desk,” she says. “Words such as ‘medical coding,’ ‘ICD-10-CM,’ ‘ICD-10-CPS,’ ‘CPT,’ ‘HIPAA,’ and ‘EHR’ will be important. Also important—especially for someone with little experience—is to list related courses that they took. Your résumé must get you noticed, so key terms, skills, and knowledge are important to display.”

Lehoux agrees that key terms are indeed important, adding, “Résumés are tricky. They need to truthfully and effectively present your skills and experience in a way that is relevant to the employer’s needs. As a new coder, without spot-on job experience, you have to explain why your experience is relevant and make the case for yourself as a good employee.”

Pratt emphasizes the value of spotlighting an academic foundation. “I’m always looking for what types of credentials prospective employees have, and what I’m looking for depends on the type of coding someone wants to do,” she says. “When I’m looking for new coders, I’m looking for an associate or a bachelor’s degree rather than someone who just has a certificate in coding. An associate or bachelor’s degree is more encompassing.”

Soft Skills

Employers often seek skills beyond academics and experience when looking for that perfect candidate. For example, excellent written and verbal communication skills are prized commodities.

“Communications are key as the field continues to move toward remote work,” Pratt says. “For the employee, working remotely is great; you can be there for kids and you don’t have to travel in bad weather. But much of the way we communicate when we work remotely is through instant messaging and e-mail. It’s very important to be professional when responding to a negative audit that appears in an e-mail. As employers, we want to know how you will respond to a manager or supervisor. You have to be able to come across as open-minded and willing to listen. You want to hear what they are saying while also defending what you are saying in a professional manner.”

Cari Greenwood, RHIA, CICA, CCS, CPC, an AHIMA-approved ICD-10 trainer and a revenue cycle product specialist at Career Step, agrees that strong interpersonal and communication skills are critical, as is an aptitude for research and computers. “It’s also a benefit if the candidate is able to speak publicly and present well,” she says.

Lehoux believes the ability to manage time, work independently, show initiative, and think critically are sought-after attributes. “Just being easy to work with—a team player—is a big advantage, too,” she adds.

Common Errors

Like all prospective employees, new coders can make mistakes when searching for that coveted position. “Being impatient is probably the most common mistake we see,” Lehoux says. “The first job will not necessarily be the last, but it is your first opportunity to learn everything you can, develop productive work habits, and start to build your network of professional colleagues that will carry with you through your entire career. Each job is a stepping stone that gives you the skills you’ll need later on in your career.”

Edgerton offers similar advice. “I think new grads want their dream job, as we all do. Getting their foot in the door in any role possible is going to help lead them there. That first job and salary might not be ideal, but if you’re working at the hospital in a related capacity, you can find a way to introduce yourself to the coding manager, ask her to lunch, and tell her about your education and career goals,” she says. “Give her your résumé. Ask if she will keep you in mind for future openings. She will likely admire your drive and professionalism and remember you later.”

Emerging coders should not be discouraged by a lengthy list of qualifications, Greenwood says. “Many new coders can be intimidated by the qualifications outlined in a job listing,” she explains. “However, job listings usually identify an employer’s ‘dream candidate.’ Many organizations will give an opportunity to someone with less-than-ideal coding experience/credentials if the candidate has other qualities that are harder to teach, like a good attitude and work ethic.”

Some new coders limit the types of jobs they seek, which decreases the opportunities for them to enter the profession. Experts agree that it is better to take any job to gain experience and build a résumé rather than wait for the ideal role.

“Another thing that new coders often do is shy away from asking questions,” Greenwood says. “They’re often worried that they are expected to know everything and, if they ask a question, it will reveal their ignorance. The reality is that no matter how many years of experience a person has, every coder needs to ask questions.”

Aspiring coders should take full advantage of the latest industry resources and industry organizations such as AHIMA and AAPC, which offer networking opportunities. “Go to state meetings. Volunteer. Listen. Read your journals and read the comments from AHIMA,” Pratt advises. “If you involve yourself, you begin to see where the pulse is, and you meet people who love to help new grads.”

Inspiring New Coders

Even seasoned coders began at the beginning, and their starting positions can serve as inspiration for those who are just entering the field.

Greenwood earned her bachelor’s degree in psychology but found she could not find a good job in that field without an advanced degree. “I became intrigued by coding because I love the science of medicine but was not interested in working in a clinical setting,” she says. “I enrolled in a coding certificate program similar to Career Step’s Professional Medical Coding and Billing course. I completed the training in nine months and then participated in a 120-hour externship at a local hospital. Shortly thereafter, I sat for and passed the CPC and CCA certification exams.

“A few months later, the hospital where I did my externship had an opening for an inpatient coder. I applied for and was offered the position, and I remained there for almost three years,” Greenwood says.

“I actually got interested in the HIM field while I was still in high school,” Pratt says. “My stepgrandmother had been in the field and talked to me about looking into it as a potential major. I graduated with an associate in HIM, took my RHIT test that same year, and passed it the first time. I got my first job thanks to my stepgrandmother, who knew someone in a nearby hospital. I was just at a front desk, greeting people in the HIM department. From there, I became a quality specialist, then worked with core measures and on a pilot program for meaningful use. Eventually, I became a supervisor and part of a leadership team, which was my ultimate goal.”

Learning Opportunities

Many educational institutions and professional organizations offer resources for aspiring coders. For instance, at Libman Education, Lehoux and her team are working with several hospitals to help them develop their new coders’ skills.

“Our ‘Grow Your Own Coder’ program assesses coders’ current knowledge, defines the goals for their training, and, through online education and mentoring, fills in the gaps between where an employee’s skills are now and where the employer needs them to be,” she says. “By using our program, the employer is able to get the employees they need without committing their already overcommitted senior staff to training the new staff.”

Endicott points out the value of gaining real-world experience through apprenticeship opportunities. She notes that the AHIMA Foundation is currently offering a Coding Apprenticeship program, the details of which can be found at www.ahimafoundation.org/prodev/apprentice.aspx.

“I began my career in a temporary, summer position in an HIM department, where I had previously done an internship,” Endicott says. “And I firmly believe that these types of practical, hands-on experiences are invaluable to launching enduring and successful careers.”