The Executive Suite: How to hire the right medical coder

Inaccurate coding remains a main cause of lost revenue for a medical practice, highlighting the value of an on-staff professional coder.

Skilled coders are in high demand, so recruiting and retaining the right candidate presents a challenge. The unemployment rate for coders saw a slight decrease from 6.6 percent in 2016 to 5.9 percent in 2017, according to AAPC’s 2017 Salary Survey of nearly 13,000 respondents. However, the average salary for all employed respondents grew 6 percent to $52,648, meaning employers will likely need to pay more to keep or attract coding talent.

“With the unemployment rate [for coders] so low, the job market for employers is more competitive,” says Raemarie Jimenez, CPC, vice president of membership and certification solutions at AAPC in Salt Lake City. “You are competing with other practices and other opportunities where [coders] have more options.”

Your current staff often can be the best source for new coding talent. “One thing you should look at is helping an internal person who you want to retain get those [coding] skills. Invest in [his or her] training,” says Laurie Morgan, MBA, partner and senior consultant at Capko & Morgan, a medical practice management consulting group based in California. “It’s not always that easy to find ways to give people career paths inside of a practice. This is one area where you really have an opportunity to do that.”

But if you lack that opportunity, you will need look externally and not only attract the most qualified candidates but also provide a competitive employment offer. Here are some tips to help ensure that you choose the right coder for your practice, and that the coder chooses you back.

Determine your coding needs

Because a coder can contribute at multiple stages during the revenue cycle, defining the coder’s role and responsibilities is the first step of the hiring process, Morgan says.

Morgan recommends practice leaders—which can include the practice manager or administrator, the practice owners, and the manager of the billing team—meet to align on what the coding job will entail and develop a comprehensive job description. “[They must decide] if this person is working only on coding or on billing as well,” she says.

A coder by trade, Astara Crews, CHC, CPC, director of regulatory affairs at ENT & Allergy Associates LLP., a group practice with offices in New Jersey and New York, says that the coder’s role often depends on a practice’s size and revenue because smaller practices tend not have the business need and/or resources to support distinct coding and billing roles.

But having a joint biller and coder role can be valuable to a practice. “Having [a biller] who is aware of the coding rules adds that extra layer of assurance that [claims] are not going out fraudulently,” Crews says.

Describe your ideal candidate

In order to screen in the best candidates, identify the qualifications and experience a coder must have to be successful in the coding position in addition to the soft skills needed to work effectively with other staff members.

Jimenez recommends limiting your scope to candidates with professional certification. “[Practices] are not giving enough weight to certifications. They will hire someone just to sit in that seat, thinking that [coding] is an easy job, and they don’t get well-trained individuals. If they’re certified, you know they’ve passed an exam showing competency.”

Keep in mind that individuals could have a compelling case for why they would excel in the position, even if their backgrounds do not exactly match the job requirements, Morgan says.

For example, do not discount candidates simply because their certifications are not specific to your practice’s setting or specialty. “If the candidate learned how to do coding successfully for several different specialties in the past, then that may be an indication that they will be very adept at learning a new specialty,” she says.

Furthermore, coders who are new to the industry can become valuable assets if training and supervision is available. “I used to work with coding externs who were completing a course and getting certified,” Jimenez says. “For me, it was beneficial [to host them] because they came with no bad habits, so I was able to teach them the way I wanted it done in our particular circumstance.”

Create a compelling job ad

Pique applicants’ interest by posting a job ad that not only includes key information about the job but also demonstrates why applicants should want to work at your practice.

Posting the job description alone will not be alluring to applicants because it will be too bureaucratic, Morgan says. “You need to convey your practice’s personality, history, and mission. Why is your practice an exciting place to work? Is your practice a dynamic place to work? A compassionate place to work?”

Also consider how digestible your job ad will be for a reader, Morgan says. For example, avoid large blocks of text and the use of obscure or vague terms to describe the job duties. Use bullet points, shorter phrases, and clear language.

Recruit from the right places

Engage in both active and passive recruitment to generate a strong candidate pool.

To reach candidates actively searching for a job, post your job ad on general job sites, your practice’s website, and social media accounts as well as job boards specific to coders, such as the AAPC healthcare job database, Morgan says. The American Health Information Management Association (AHIMA) also offers a service called AHIMA’s Career Assist that can connect employers with coders.

Social media provides an opportunity to connect with individuals who may not be looking for a job but have the skill set you need. On LinkedIn, individuals often list credentials after their name, so you can identify certified coders and reach out to them, Morgan says.

Your current employees are an additional source for new referrals. However, smaller practices may need to be more cautious. While you should let your staff members know the position is open and invite them to nominate candidates, “you want to have some boundaries,” Morgan says, who thinks paid referral programs are especially risky for small practices. “You don’t necessarily want relatives working with one another. If you have a very small team, having people who know each other too well from outside of work can introduce drama.”

Ask the right questions

Use interviews to ascertain if candidates possess the necessary coding acumen as well as the soft skills to be successful in the coding position.

Brief phone interviews may prove useful if the size of the candidate pool is substantial. Conduct these calls with applicants to learn more about them, their background, and level of interest in the position, Morgan says, noting that open-ended questions that allow applicants to talk about their skills and interests are best (Why are you looking for a job? What attracted you to apply to this position? Why is this position a good fit for you?). If an applicant still seems like a good match after the phone interview, then bring him or her in to interview with the manager and other relevant staff members, she adds.

Jimenez suggests asking candidates about previous coding jobs they’ve had and what roles they’ve performed, their productivity and accuracy rates when selecting codes, and the results of any audits. She also recommends requiring an initial assessment to test candidates’ ability to complete the type of coding expected by the position.

It’s also important to pose behavioral or situational questions to determine how well a candidate is able to work with others. While some coders may spend the majority of their time pouring over charts in the back office, a practice really should look for a coder who can communicate reasoning behind a code selection, navigate through disagreements with a physician or other staff members, or simply share new findings, Crews says.

“As a coder, the primary function is not only to code a service but also to interact with [the team] as part of education,” Crews says, noting that a coder needs have interpersonal skills and be adaptable to change.

Offer competitive compensation and/or relevant perks

As a competitive salary typically is the main draw to an open position, consider setting the salary for your coding position in line with what other practices provide.

The AAPC salary survey calculator is a useful resource for practices that want to judge if their compensation offerings are competitive, Jimenez says. The calculator allows employers to search the average state salary by certification, education level, and healthcare work experience.

But if your practice cannot afford to match what other practices pay, additional benefits such as a 401(k), vacation days, and sick leave can make your position more attractive. Coding also lends itself to remote work, which Jimenez says can “can be a significant financial saver for the individual and employer” as well as offer the individual more flexibility and work-life balance.

Crews suggests providing career growth opportunities and support to attract candidates. Think about covering the cost of the coder’s continuing education units that are required to maintain certifications, membership dues to professional organizations, or providing financial support and time off to attend professional conferences, she says.

“To be competitive, I think a practice should look at the individual as not just a body to fill a seat or a body to fill a coding position … but look at the individual as a whole and try to recruit individuals based on what they have to offer,” Crews says, stressing that “not so great salary” can be offset with opportunities for professional growth and development to successfully attract coding talent.