Hiring a Coding Ace for Help with ICD-10

By Torrey Barnhouse

HIM departments have already spent considerable time and resources providing ICD-10-CM/PCS training for coders. Between now and October 1, 2015, they’ll spend even more.

In addition to training current staff members, HIM directors and coding managers will likely hire new coders to fill gaps during ICD-10-CM/PCS training, support dual coding initiatives, and prepare for anticipated productivity decreases. Other HIM staff members will also be needed throughout 2015 as HIM departments absorb additional responsibilities such as clinical documentation improvement and audit management.

Throughout this hiring frenzy, HIM directors and managers need the reassurance of knowing that any new team members they bring on board will be committed to the organization for the long haul. They need to ensure that candidates aren’t simply looking for a quick fix until the next best job comes along. Commitment must be a critical hiring criterion.

This article explores seven strategies for recruiting the best HIM candidates. From coders to release of information staff, this article answers HIM’s most important hiring question: How do I separate candidates who are driven and dedicated to the organization from those who simply seek a paycheck and insurance benefits?

Consider the following seven strategies to find top-notch coding and other HIM department professionals.

1. Look for job flexibility

Flexibility is a universal asset in healthcare, and today’s professionals must be able to articulate how they intend to survive and thrive in a dynamic department. For example, coders are often asked to perform non-coding duties, such as abstracting, clinical documentation improvement (CDI), and even data analysis using the EHR.

The HIM task list will only continue to grow in light of ICD-10-CM/PCS as organizations look for new ways to tap into the power of big data. Look for someone who can handle each transition with ease and enthusiasm.

To gauge flexibility, first consider the candidate’s resume and ask these five questions:

• Has the candidate held a variety of positions within their current organization?
• Has the candidate participated in a variety of projects or had different responsibilities?
• Have the candidate’s responsibilities changed over time and how has he or she handled these changes?
• Does the candidate want to gain more professional experience, or is he or she simply trying to avoid new responsibilities in their current role?
• If the candidate’s resume reflects many job changes in a short period of time, ask for an explanation.

If you sense a candidate’s unwillingness to adapt to change—or a general frustration with change—this may be a clue that he or she is not a good fit for your organization.

2. Seek those who value lifelong learning

Coders, by nature, are inquisitive and critical thinkers. However, as the industry moves to ICD-10-CM/PCS, coders must also demonstrate their ability to perform in-depth research regarding coding guidelines as well as clinical procedures and diagnoses. They must continually strive to improve the quality of their coding—the same holds true for other department staff. Here are five points to consider during the interview process:

• Look for individuals who are high academic performers.
• If the candidate hasn’t obtained advanced degrees or certificates, ask how they would approach the coding of a complex medical record. Would the candidate perform additional research, if necessary? If so, how?
• What steps would the candidate take to research a different HIM process or procedure?
• What types of continuing education events does the candidate enjoy, and why?
• How does the candidate stay abreast of coding and other HIM changes?

3. Make effective communication skills a priority

Communication skills are important in any job, and they’re especially important in HIM. Coders must be able to communicate with physicians, CDI specialists, other managers, colleagues, and perhaps even patients. This may be for purposes of providing education, querying, or gathering other information.

Coders or other HIM staff who work remotely must have exceptional interpersonal skills, as they won’t be able to rely on the nonverbal nuances of face-to-face conversations. Although hiring managers can get a general sense of a person’s communication skills during the interview, they should also consider the following:

• Correspondence (i.e., voicemails and e-mails) before and after the interview. What is the tone of these communications? Is it professional and respectful? Did the candidate take the time to proofread the information? Is written communication expressed with clarity and accuracy?
• Social media. How does the candidate communicate with others on sites such as Facebook and LinkedIn? Does he or she understand how this information affects perception? Are the communications appropriate for public viewing?
• Responses to real-life scenarios. During the interview, ask the candidate how he or she would respond to a scenario that recently occurred within the organization. This scenario could be a disagreement that occurred between two coders, a difficult interaction with a physician, or even a confrontational experience with a patient. What would the candidate do and say to defuse the situation?

4. Seek a well-rounded candidate

HIM professionals who have worked in a variety of settings (i.e., hospital, clinic, physician practice, payer organization, etc.) are particularly valuable. That’s because healthcare is becoming increasingly integrated. As organizations expand to include facility-owned physician practices or become part of ACOs, the demand for seasoned staff who can adapt to different scenarios increases.

Even if a candidate hasn’t worked in multiple settings, there could be other clues to indicate that he or she values a well-rounded career. For example, those who actively participate in their AHIMA state chapter or attend AHIMA’s Annual Convention and Exhibit demonstrate a commitment to keeping tabs on new developments within the industry. Likewise, someone who has contributed to a blog, authored an article, or given a presentation to peers also demonstrates a willingness to tackle new tasks and embrace new experiences.

5. Test for accuracy

Coder testing is quite common in most organizations. However, the method of testing has evolved. In the past, testing typically required coders to achieve only a correct DRG. They weren’t penalized when they missed one or two codes that did not affect DRG assignment. Now, the best practice is to ensure code-level accuracy—that is, coders must identify, capture, and sequence all codes properly, including those that don’t directly affect the DRG.

Why is this important for hiring an “ace” team of coders? Organizations increasingly rely on the granularity of coded data. They use this information to make important clinical and business decisions. Organizations are mindful of the fact that the information that coders report via coded data is used to determine mortality rates, patient safety indicators, quality ratings, and more.

Hiring managers need to know that candidates take their role seriously in this highly transparent healthcare environment.

In addition to testing for coding accuracy, organizations should test a candidate’s ability to perform queries. Do so by including a scenario with insufficient documentation. Provide query templates, and ask the candidate to assess whether and how the templates would be used. Can the coder communicate effectively with physicians to obtain the necessary information?

6. Don’t wait for the perfect candidate

It’s naïve to think you’ll find a candidate who possesses all of the desired skills and experiences. Organizations must realize that even a well-suited candidate requires continuous investment in terms of training. There will always be new technology and other changes within the industry that will require ongoing education. According to Sheryl Sandberg in her popular book, Lean In: Women, Work and the Will to Lead, candidates should apply for new positions even if they don’t meet every single criteria.

However, don’t feel pressured to hire a half-skilled candidate either. If candidates aren’t properly vetted, they could cost the organization more in the long run.

7. Stay focused on the present with an eye toward the future

If managers can’t find a suitable candidate, they should consider creating an apprenticeship program. Many organizations are creating these programs to incorporate new graduates into the workforce. Eager for real experience, new graduates are among the most driven and capable individuals that an organization could hope to hire.

HIM directors could train internal coders to become mentors for these new hires. In return, these mentors can then provide training to the new graduates regarding facility-specific practices.

The bottom line is that the HIM profession, and in particular coding, will continue to evolve commensurate with technology. Organizations need to align themselves with candidates who are willing to adapt accordingly and continually strive to perfect their skills.

Candidates who see HIM as a function—and nothing more—will be a detriment rather than an asset. This is the question that hiring managers should ask as they interview candidates during this important time of transition in the industry.

Torrey Barnhouse is the founder and president of TrustHCS, a firm dedicated to serving the coding auditing, ICD-10 preparation, clinical documentation, and revenue integrity needs of healthcare organizations. Barnhouse actively participates in a number of professional advisory groups and has served on the Board of Directors for community-based not-for-profit organizations. He currently serves on the AHIMA Foundation Board and the Remington College HIM National Advisory Board.