Looking Beyond an Employee's Coding Credentials

By: Aimee Wilcox, CPMA, CCS-P, CST, MA, MT, Director of Content

In today's ever-changing healthcare environment, it is important that organizations hire coding and reimbursement personnel who enjoy learning. Each year changes are made in how healthcare services are coded and reported from federal and state laws, the code sets themselves, and varying payer policies. During the public health emergency (PHE) 1135 waivers brought about an onslaught of daily, sometimes hourly, changes that were financially significant to hospitals and provider organizations. Due to the complexity and comprehensive nature of the tools used to manage healthcare coding and reimbursement, management must be committed to hiring employees that are not only up for a challenge, but who are excited about learning and expanding their skills and experience.

When interviewing applicants for potential hire, greater consideration should be given to looking beyond an applicant's coding credentials, whether they be newly certified with no experience or certified with many years of experience, to identify those who are not only qualified by education, training, and experience, but who are also excited about learning, identifying opportunities for growth, and implementing needed changes. Change is a word that frightens many, but in medical coding and reimbursement, it is a word that means it is time to rise to the challenge of learning new information (e.g., codes, regulations, guidelines) and incorporating that knowledge to benefit the healthcare organization where employed along with the individual.

While the professional services of physicians and providers create job opportunities for coders and reimbursement specialists, when managed correctly, these experts make it possible for physicians and providers to continue caring for patients by ensuring a steady and consistent flow of revenue due to instituting correct documentation practices, code assignment, and reimbursement methodologies. Additionally, when annual or unexpected changes occur, the ability for these experts to identify, learn, and apply new information and guidelines is vital in preventing financial losses or risking accusations of fraud and abuse that could devastate the organization. 

Due to the constant changes occurring in coding and reimbursement, making sure those who interview and hire employees are asking the right questions has become more important than ever. Some beneficial questions may include:

• While preparing for your certification exam, what did you enjoy learning about the most?
• How would you approach a service that is repeatedly denied by the same payer?
• Tell me about your preferred working environment. 
• Would you tell me about a time you were required to change the way you did something at work and how you approached that process? 
• Now that you've completed your certification, what are you planning on doing next to advance your career? 
• When you learn something that makes your work easier, how will you use what you learned to help this organization?
• Tell me about a time when you worked on a team project successfully and what made it successful.
• Would you be willing to accept and complete additional educational opportunities that would benefit this organization and yourself?

The truth is, newly credentialed coders have just scratched the surface of all there is to learn about coding and reimbursement. Their education taught them how to identify services and diagnoses within a medical report and translate them into codes to report on a claim form to an insurance company for reimbursement but once they begin working in their profession, the opportunities for growth are endless. The applicants responses to these questions can provide insight to how they view and value continued learning, collaboration, and understand the expectations of keeping up to date on coding changes for the duration of their career. Hiring the right person for the right position is a benefit to both parties and opens the coders eyes to the many possibilities for growth that exist in this field of work. For example, just in the world of risk adjustment (RA) coding, a coder needs to become an expert at assigning the correct diagnostic codes based on the coding guidelines and rules and once they have gained enough experience, may be presented with opportunities to audit or train other RA coders, teach, write articles, or manage these departments. 

As important as it is to hire individuals who are excited about continued learning to the benefit of the organization, it is equally important that these organizations create an environment that fosters learning through opportunities such as attending webinars and conferences, researching coding problems to resolve them, and sharing their knowledge with co-workers to the benefit of all. Healthcare organizations that provide and pay for these continuing education opportunities have an opportunity to pick and choose topics that benefit the organization while creating variety in the workplace and ensuring coders maintain their hard-earned coding credentials through continuing education units (CEUs) earned.

Being an organization that promotes and rewards learning creates an organization in which employees enjoy their work and feel they can make a difference, resulting in an improved bottom line and fewer compliance issues. Isn't that best of both worlds scenario what we are all looking for?