Tuesday, November 10, 2009
Over the last year I've watched my father look for a new job after giving 35 years as a machinist to a manufacturing company. Last year, his company moved operations out of the country and laid off hundreds. And as he goes on interview after interview, it's unfortunate to see that his 35 years of experience is not seen as an asset, but rather as a method to "do the math" and see when he might be ready for retirement.
I am happy to report that my father was recently offered a job and starts next week. We all have our fingers crossed that this will be the good fit he's been looking for. But for the rest of the "mature" job seeking population out there, I recently came across a blog with some good advice. So if you are over 40 and looking for employment, check out this link: Interns Over 40.
Tuesday, November 3, 2009
In talking to some of the schools represented at the exhibits, I realized a lot has changed since I graduated and took my RHIT exam. Of course, I already knew this, but I never really thought about how different it is to network into a new position in this new educational system. As students seek out more online education opportunities and medical records move to an electronic format, schools are able to set up virtual labs to closely mimic the real world. The unfortunate drawback to this is that as a society, we've become so "virtual" that employers are seeing an increasing need for soft skills, or those social skills associated with a person's emotional intelligence quotient (EQ).
Soft skills include things like verbal and written communication, the ability to work in teams, motivation, conflict resolution, and leadership. I am neither qualified nor interested in writing a blog about the importance of EQ, but I thought I would present my opinion on the subject and include a few tips - things to think about before going for an interview - that might give you an edge in getting noticed and getting hired.
What WALL-E Has to Say About EQ
In thinking about soft skills and EQ, I am reminded of the movie WALL-E, which, although a kids movie, has some very poignant messages for adults. If you haven't seen the movie, I highly recommend it. The part relating to EQ is the human part of the story where the humans have been living for over 200 years on a spaceship. When we first see the humans, they are riding around in hovercraft equipped with laptops with messaging capabilities and they are glued to their computer screens. They communicate through their computers and ignore everything else around them. It's not until the robot WALL-E accidentally knocks a man and a woman out of their hovercraft that the humans begin to realize they can converse face-to-face.
Now I'm not saying we live in a WALL-E world, but there are days when I think we are headed in that direction. I work remotely 50-75% of the time and most of my work is done using the computer, internet, and phones. This makes it possible for me to work for a client in another state without the expense (or frustration) of airline travel. This is a great thing but the other 25-50% of the time I am face-to-face with clients, colleagues, and students and I firmly believe that no matter how I present myself online or over the phone, what matters most is how I interact in person. Even if you want to work from home, chances are you will need to interview in person, or even via web cam. So how you convey yourself in that initial meeting matters.
Get Off Social Networking Sites and Go Meet People
Social networking is the latest in personal, business, and marketing communications. Facebook, LinkedIn, and Twitter are heavily populated by people wishing to connect or reconnect and I'm all for that (find me at the Coder Coach on Facebook!). But social networking is only one tool and you need to get out and meet people. So if you are planning to get a job in the industry, you need to meet people face-to-face. Look for local seminars and AHIMA/AAPC chapter meetings where you can meet other coding professionals. I am much more likely to recommend and endorse someone I've met personally versus someone I've met online.
But meeting industry professionals is going to be tough. As mentioned, today's technology lends itself to remote work and more and more coders are working from home. In addition, hospital budget constraints often mean coders must pay for their own continuing education and either take paid leave or no pay to attend classes. As an alternative, many coders are opting for distance education in the form of online courses, audio conferences, and webinars. This means less of a networking pool for novice coders. So seize every opportunity you can to network in person with coding professionals. Check out your local AHIMA or AAPC chapters to find something close to home. If all else fails, find a local mentor and meet with them on occasion. Once you meet one person and they start to introduce you around, you will be amazed at how quickly your non-virtual network grows.
We're all told that we need to look at people for who they are rather than how they look. Well, in business, how you look matters. I am not saying everyone needs to go out and get plastic surgery, but here are some tips:
1. Dress for the job you want. I think we've all heard this one before and it's true. Look at people who are in the industry in the positions you someday hope to hold and emulate their dress patterns. This is true even during networking events, such as seminars, meetings, and educational events (other than traditional classroom education). Pay attention to conference brochures - they usually tell you what is appropriate (business, business casual, or casual). If you are networking with potential employers, I always recommend either business or business casual, but never casual. You want to send a message to employers that you are serious about your career.
2. Observe standard corporate business attire - unless given permission to relax the rules. I realize this is the 21st century, but there are still some old fashioned rules that may never go out of style. You can google "proper business attire" and get a million hits on what to wear. Here is my personal take on it. For women, skirts should be no more than 2-3 inches above the knee and leg coverings are recommended (at least for the first meeting). Dress slacks are fine, but foot coverings should be worn (again, at least for the first meeting). Don't wear cropped or capri pants - even if they are dressy - for interviews. Some places may accept them, but not others and you want foolproof attire on the day of an interview. Avoid jeans, t-shirts with printed letters or logos, tank top, sleeveless tops, halter tops, short skirts, sandals, tennis shoes, or shorts. For men, business attire generally includes slacks with a button down shirt that can be worn with or without a tie or jacket depending on the formality of the setting. Men should avoid jeans, khakis and polo shirts (unless business casual dress is called for), t-shirts, tennis shoes, and sandals.
3. Ignore what everyone else is wearing (except for your mentor whose job you someday hope to hold!) and dress for the occasion. When you are looking for a job you want to stand out from the crowd (in a good way!). Now is not the time to be pressured into sloppy dressing by your peers.
4. Remove additional piercings and cover tattoos. A former coworker comes to mind here. As a traveling consultant, it's always interesting to see your coworkers dressed down during non-business hours. Many days a team of consultants looks like a group of agents from the movie Men in Black with conservative black business suits. So imagine my surprise to see one such male consultant sporting an earring at the airport. Maybe there were tattoos too, but I never saw them. The point is - business is still conservative. It's okay to have the tattoos and piercings, but portray a more conservative image when you are meeting a business contact for the first time.
5. Tone down hairstyles, makeup, and accessories. I love movie references, so here's another - think about the movie Working Girl where Melanie Griffith's character starts out with huge 80s hair, loud makeup, and over-sized accessories and ends up with smart business suits with subtle accessories (and Harrison Ford!). I admit, this is a hard one for me because I love accessories, but I try to wear one statement piece and tone down everything else. If you have color in your hair that is not normally found in nature (e.g., pink, purple), think about styling it in a way that the color is not so noticeable.
6. Don't wear cologne or perfume. You might think you smell nice and maybe other people do too, but particularly in health care institutions, people have allergies. You don't want to offend your future employer by making him/her sneeze. Many hospitals and doctor's offices have a no perfume/cologne rule for the sake of workers and patients. So save your best fragrance for a night out.
How You Write Matters
I am going to try to be very careful here and not get on my soapbox, but I will say this: I am appalled at where we are with written communications these days. I'm all for texting and instant messaging and "LOL-ing" but there is a time and a place and text lingo doesn't apply in business when you are trying to get hired. If you are emailing potential employers, ensure that your communications are professional and contain no typos. If your email has a spell check option, use it, and always read your emails through before hitting send even if you use spell check. After all, "form" and "from" are both words in the English language, but they cannot be used interchangeably in a sentence.
Your resume should also be text-lingo and typo free. I fully admit that I have set resumes aside, even if the candidate is seemingly qualified, because of the typos. I have a natural tendency to edit, so if I get out my red pen just to read a resume, then I am too distracted by the typos to read for content. So write your resume and read it over several times. Better yet - give it to a friend to read to make sure you didn't miss anything. You don't want to be set aside because of a poorly written resume.
I really hate cliches, but they're cliches for a reason: they bear repeating. Case in point: don't say anything you wouldn't want printed on the front page of the newspaper. The coding industry is small. This is an excellent networking tool because you can generally get introduced to just about anyone in the coding industry through someone you already know. The downside to this is that people talk. And you don't want them talking about you negatively, so be careful what you say about others in the industry and to whom.
I once interviewed someone who didn't work out and later heard her bad-mouthing me at a conference. Needless to say, I never will hire her in the future. We all have those people who grate on our nerves and we work with people whose personalities just clash with out own. My best advice here is to maintain professional interactions when necessary and never say a negative thing about that person to anyone. The type of reputation you have is up to you. You can be the hardworking team player or the trouble maker.
There are a lot of websites and blogs out there dedicated to getting hired and standing out. So rather than rehashing all of those, if you want more information, I listed some links below that might be of interest to you. And since I am such a movie buff, let me offer another recommendation: The Secret of my Success starring Michael J Fox (1987). I love his enthusiasm as a recent grad trying to make it big in business in New York. Most of all, he has such faith in himself and it drives him (unconventionally) to great things. At least you'll get a good laugh out of it (I hope!)
-Personal Branding: 5 Questions to Ask Yourself
-Proper Business Attire:
Friday, October 2, 2009
Wednesday, September 9, 2009
A lot of schools will tell you all about their coding programs, but what they may not tell you is what the local job market looks like. And as more and more distance education schools pop up, it becomes your responsibility to find out if there is a need for coders in your area. While it is true that there is a national coder shortage, there is no guarantee that coders are needed in the geographic location where you currently reside. So how badly do you want to be a coder? Are you willing to move somewhere else if there aren’t positions close to you?
Where the Job Postings Are
The initial research is simple. Check local and national job postings. This may mean going to a variety of sources, such as the local newspaper, AHIMA, AAPC, and employer job listings. Don’t expect to find a whole lot in the newspaper ads (although smaller physician practices still use newspapers to post positions), since there are many professional job listing sites and coding positions are highly technical; therefore, most employers go with the professional job listings. Some employers may not have an advertising budget, so I always recommend that you hit their job listings on their websites. For example, if you live within 20 miles of 5 hospitals, check the job listings at all five. And don’t stop there. If you are a member of AHIMA or the AAPC (or both) check their job postings for your area. Look at the national postings if you are able to travel. And also don’t forget to check job postings in industry publications (see my previous post titled “What Should you be Reading?” for details).
Pay Attention to Job Requirements
Everyone wants experienced coders, that’s a given. But they don’t always find them, so don’t stop reading once you’ve seen they are asking for someone with 2-3 years of previous experience. The important thing to note within the job requirements is this: which credentials are they looking for? If you are not certified, this will give you an idea of which credentials are in demand for the employer you want to work for. It will also clue you in to the current job market and you will know if there is more of a need for physician or hospital coders, inpatient or outpatient coders, or even if there are some nontraditional coding positions. Look for those “code” acronyms (pun intended!): ICD-9-CM, CPT, HCPCS. If the requirements to land the position include an understanding of one or more of those, then it’s a coding-related position. And even if you can’t be a “traditional” coder, being in a coding-related position is a start.
I’m sure I’m starting to sound like a broken record about now, but I can’t stress this enough. I have known a fair share of people who were hired because they were in contact with someone who was hiring. This remains important throughout your career. This is a small industry and you will find that you continually cross paths with the same people and as you advance, you may find that employers are courting you. But until the day your name is on the tip of every hiring manager’s tongue, focus on getting your resume straight to the hiring manager and you will be more likely to get an interview or test for the position.
Know Your Stuff
Knowing people is one thing, but I personally don’t endorse or hire anyone until I can vouch for their coding abilities. I’ve never hired anyone without issuing my own coding test, so be prepared to be asked to take one. Being a novice coder is okay and a good coding test will test your skill at any level, but you do need to know at least something about coding. If you don’t know how to locate codes in the ICD-9-CM and CPT codebooks or medical terminology, it’s going to be a short interview. So make sure you at least know the basics before going in. You can further prep by attending local educational seminars and reading trade magazines, which will help educate you and introduce you to industry lingo (and there’s a lot of it). I’m sure this makes little sense right now, but the more you know as a novice, the better off you are (again, please see my post on what you should be reading). My next post will help make this clearer. After all, coding is more than just looking up a code as if it were a word in the dictionary. Stay tuned…
Monday, August 31, 2009
So what should be on your reading list? Let’s start with the basics for the job. Of course you need the latest version of any and all of the codebooks for the health care setting in which you work. For most of us, this list includes ICD-9-CM, CPT, and HCPCS Level II. And yes, you need the current year. While not all of the codes change annually, some of the changes can be significant enough to render the previous year’s codebook useless.
ICD-9-CM codes are effective October 1 of each year and if you don’t have an employer who provides this book for you and you’re responsible for ordering your own, be careful to order the right one. While ICD-9-CM has various publishers (e.g., Ingenix, Channel), the content is the same. However, you can choose the format you like best, for example, some publishers offer color codebooks, others may have illustrations. The format is not important, but if you are working in a hospital, be sure to get all three volumes (I, II, and III). If you are a physician coder, the “professional” edition, or one that contains only volumes I and II, is sufficient since volume III codes are not used in doctors’ offices.
CPT codes are effective each year on January 1 and are published only by the AMA, although you can usually order them through other publishers as well, or even through the AAPC at a discounted rate if you are a member (are you seeing the benefits of joining coding organizations yet?!). HCPCS Level II is another story. While the book is published annually with the calendar year, the Centers for Medicare and Medicaid Services (CMS) adds to the list quarterly and these updates are posted on their website. HCPCS Level II books can also be ordered from any codebook publisher and may be offered in various formats.
Once you have your codebooks on the shelf, you need some clinical references on hand. First off, this means an anatomy book. You also need to know how all those anatomical parts work – or physiology. So you if you haven’t invested in an anatomy and physiology book, this is a wise investment. Other clinical references that come in handy are a pathophysiology book, medical dictionary, and book of acronyms. The pathophysiology (or disease process) book will help you connect the dots while you code. This is what will tell you that hypotension and fever are common symptoms of sepsis. The medical dictionary is a given – I still use one even after taking 2 semesters of medical terminology and coding for nearly 15 years. And the acronym list, well, should be self-explanatory if you’ve ever looked at a medical record (for example: “45 yo WM c/o CP and SOB x24 hrs” = “45-year-old white male complaining of chest pain and shortness of breath for 24 hours”). If you want to go a step further and like to study, invest in a medical terminology book. Medical terminology books are not just medical dictionaries; they will often take the Greek or Latin root of a word and expand from there. Once you know basic Greek and Latin roots, the medical dictionary is not needed as much.
But wait! There’s more!
Remember how I said that coding was dynamic? Well, it’s so dynamic, in fact, that the annual and sometimes quarterly code revisions are sometimes outdated by the time the ink is dry, so you will need to invest in periodicals discussing the latest and greatest in the world of coding. If you joined AHIMA or the AAPC, or both (and I highly recommend you do; see my blog post titled “Getting Involved” for more details) you will start to receive publications from them on a monthly basis. Read them. AHIMA publishes the Journal of the American Health Information Management Association and various other publications including e-newsletters. You can control what you receive and how by managing your profile on AHIMA’s website once you are a member. The AAPC publishes Coding Edge and it’s nothing but coding information from cover to cover. They also send out e-newsletters on a regular basis. Looking for more? Another industry standard is Advance for Health Information Management, a **free** publication that includes a regular column titled “CCS Prep,” which discusses scenarios to prep coders for the AHIMA examination. Did I mention it’s free?! And there are job postings in the back of the publication. That means there are no excuses not to be reading it. Another good magazine is For the Record, which is free for AAPC members and people residing in certain states.
Want to know more about coding as it relates to reimbursement? To delve into the world of MS-DRGs, APCs, fee schedules, and prospective payment systems, visit CMS’ website and start browsing the listings. You can also sign up for listservs to receive updates. Be careful, though, and don’t sign up for everything. Do you have any idea how much CMS is working on at any given moment? You don’t want to overwhelm yourself! If you are a newbie, try out Medicare’s Learning Network. If you want to know where all those government billing guidelines are written, try out the manuals section.
If you are a beginner coder or CMS’ website is too intimidating for you (and don’t feel bad if it is– some days it still freaks me out a little and I use it nearly every day!), I recommend getting on the mailing lists of some of those consulting companies who offer free e-newsletters. Sometimes they will explain the coding and reimbursement for a topic in a way that is way less confusing than government speak! HCPro offers a laundry list of e-newsletters – some are free and some are not. Integrated Revenue Management, Inc. offers a free monthly e-newsletter called “Net Revenue Matters” that has general information about health care revenue cycle updates, but usually has at least one coding article.
And finally, never underestimate the power of Google! While it is true there is a lot of junk on the internet and you need to be careful where you get official coding and reimbursement advice, Google can sometimes get you to a website that will get you to another website that will get you an answer. If you are searching for clinical information, Health Finder is a search engine developed by the US government and all of the sites listed have been verified as legitimate. Emedicine has some great articles authored by physicians that can help with learning about particular diseases and procedures.
From "Born Yesterday" to Seasoned Professional
So get ready to read up and don’t feel discouraged if it sounds like Greek at first. My mother always told me that knowledge isn’t what you know, it’s whether or not you know where to find the answer and the resources listed here should get you started on finding answers. If you need to look up or google every other word or phrase, don’t fret. I’ve been there. Have you ever seen the movie “Born Yesterday” (originally made in 1950 starring Judy Holliday and William Holden and then remade in 1993 starring Melanie Griffith and Don Johnson)? In the movie, Billie (played first by Holliday and then by Griffith) is learning to read difficult books and always has a dictionary next to her. There are days when coding feels like this, but then by the end of the day you feel maybe just a little bit smarter!
Advance for HIM
For the Record
Integrated Revenue Management, Inc.
Monday, August 24, 2009
As Past President of the Northern Colorado Health Information Management Association (NCHIMA), I am currently in possession of the association’s archives dating back to 1960. On August 7, I was asked to give a presentation chronicling our association’s history. I’m sure that many people would look at 40 years of archives (which had been neatly thinned and organized by a former board member) as tedious and intimidating, but I found the process enthralling. The issues of the day, the speakers’ topics, and the sense of community as well as seeing the names of “new” professionals in the meeting minutes who would later become industry leaders and mentors, left me so excited I was, at times, actually shaking with enthusiasm (this is a common side effect of being a super-coder-geek!). On more than one occasion, I picked up the phone and called my mom, a veteran HIM-er, and told her about all the treasured tidbits I had found.
But with all my enthusiasm, I was worried. Worried that only a geek like me would find that information interesting. Worried that the presentation was lacking of my usual fervor to use pictures and other visual aids. Worried that no one would make the 2-hour drive north of Denver for the presentation and I would be left presenting to anyone at the hospital who would listen. Worried that my Power Point was too purple (this is a big problem with me, given that purple is my favorite color)!
My fears were completely unfounded, though. I had recently spent time “yearbooking myself” on the website www.yearbookyourself.com (this picture is of me in "1960" - check out the website for yourself and see how you would look!), where I could upload a picture of myself and see how I would have looked with various trendy hairstyles from 1950 through 2000 and those pictures ended up in my presentation. The once nauseatingly purple Power Point presentation became a soothing shade of blue and I was excited to be the one to present this information to what happened to be a decent size group of about 20 people. And they were excited about the information. And I again felt that sense of community.
What’s my point? Well, we all need community because that’s how we get “discovered.” Very few movie stars are discovered sitting in a coffee shop minding their own business. Most work hard to get the roles that get them noticed and a well-prepared audition is often the career-launching vehicle they’ve been waiting for. A single man isn’t likely to find the woman of his dreams by spending all his time playing ball with the guys – he has to go where the women are. Likewise, novice coders are not likely to get hired without being noticed and in order to get noticed, you have to go where the professionals are.
Imagine meeting rooms filled with a dozens, or even hundreds, of coding professionals. And imagine that during such a conference, time is set aside for networking. It’s not fiction. It happens all the time. And all you have to do to get started is join one or both of coding’s premier national organizations: the American Health Information Management Association (AHIMA) and the American Academy of Professional Coders (AAPC). Let’s face it, in every business, who you know is almost as important as what you know. When I was going to school, we were strongly encouraged to join AHIMA. The great thing about AHIMA is that you automatically also become a member of the state component association for the state in which you live. So by joining AHIMA, I was also a member of the Colorado Health Information Management Association. I will never forget attending my first CHIMA meeting with my mother, who introduced me to all of her contacts. She stressed the importance of getting to know people and at the time I didn’t fully understand why. Years later, I became certified through the AAPC and it functions much like AHIMA in that as an AAPC member, you are an automatic member of your local chapter. And most local chapter meetings are free.
I cannot stress enough the importance of networking with the coding community. When I graduated, I was offered two jobs: one from the woman who gave my mom her first job and the other from the hospital where I had interned during my final year of college. I have received job offers and inquiries from many people who have crossed my path along the years – my current position included. And it is these networks that I have tapped into in spreading the word about The Coder Coach and am working to increase in an effort to help the wanna-be coders of the world get placed in positions.
AHIMA vs. AAPC
I get asked this question a lot: which organization should I join, AHIMA or AAPC? I am not here to promote one organization over the other. I happen to belong to both, so I will try to give you an objective response. In general, AHIMA credentials are more recognized by hospitals whereas AAPC credentials are more widely recognized by physician practices. Having said that, I will tell you this: these are the only two major accrediting bodies for coders. Beware of getting credentials outside of these two organizations.
I am not saying that all other coding credentials are bogus, but I have seen people get coding credentials that no one in the industry has ever heard of. There are some specialty credentials, such as the Radiology Certified Coder (RCC) that are also of good repute and are accepted by coding professionals. If you are looking into a coding credential that is not affiliated with AHIMA or AAPC and would like to know if it is well recognized, I would be happy to answer any questions you have via email (firstname.lastname@example.org).
The statement I made above about AHIMA being for hospitals and AAPC being for physician practices is not a hard and fast rule. The lines between the two organizations are becoming a bit blurred as many professional coders get dually credentialed through both. Both organizations offer credentials in both hospital and physician coding. And I have seen many AAPC certified coders working in hospitals. But if you want to find an easier time getting hired, I recommend getting certified with the organization most widely associated with the type of coding you prefer. Better yet – check local job listings for coders and see which credentials they require. You will likely find that they require at least one of the following popular credentials. Please note that with the exception of the RHIA and RHIT credentials, college degrees are not required for certification.AHIMA
- Registered Health Information Administrator (RHIA) – bachelor’s degree in health information management with completion of board examination covering HIM topics as well as coding
- Registered Health Information Technician (RHIT) – associate’s degree in health information management with completion of board examination covering HIM topics as well as coding
- Certified Coding Specialist (CCS) – demonstrates excellence in coding hospital inpatient and outpatient records; recommended for people with at least 3 years’ coding experience
- Certified Coding Specialist (CCS-P) – demonstrates excellence in coding physician records; recommended for people with at least 3 years’ coding experience
- Certified Coding Associate (CCA) – demonstrates competency and general knowledge of coding rules and guidelines; eligible for entry level position
- Certified Professional Coder (CPC) – demonstrates on-the-job experience and proficiency in physician coding
- Certified Professional Coder – Hospital (CPC-H) – demonstrates on-the-job experience and proficiency in hospital coding
- Certified Professional Coder – Payer (CPC-P) - demonstrates proficiency and knowledge of coding guidelines and reimbursement methodologies for all types of services from the payer's perspective
- Certified Interventional Radiology Cardiovascular Coder (CIRCC) – demonstrates proficiency in coding of interventional radiology and cardiovascular coding
- In addition, AAPC offers various specialty credentials certifying the coders’ proficiency in coding for certain medical specialties
- Apprentice credentials (denoted with the suffix “-A” following credential) are given to coders who pass the examination but lack the required experience for a full credential
Worth the Money
So if you are in school for coding, or trying to get a job, you need to join up. There are annual dues associated with these associations that can seem daunting – especially if you are a student on a budget. But check out the student membership rates and remember that the cost of the membership pays for itself when you land your first coding job. Best of luck and I hope to see you soon at a coder convention through AHIMA or the AAPC!