Preparing for a Coder Shortage—Tips for Hiring and Training New Coders

by Mary Butler

In this web series, HIM professionals working in emerging roles give advice on tackling difficult HIM problems.

The HIM Problem

Even with the delayed compliance date, the demand for coders trained in ICD-10-CM/PCS is growing. Because it can take months for health systems to train coders, coding managers must think strategically when it comes to hiring and training new coders without causing disruptions in productivity.

The HIM Problem Solver

Patricia Bower-Jernigan, RHIA, system-wide coding director at Allina Health, Minneapolis, MN

Coders Waiting in the Wings

While turnover in Allina Health’s coding department remains at a low two percent, Bower-Jernigan, who oversees the department, has increased the number of coders 16-fold in the last year. While many healthcare systems have bulked up their coding staff in anticipation of ICD-10-CM/PCS, Allina Health did so due to the number of long-term staff nearing retirement age. Bower-Jernigan says she worked with Allina Health’s human resources department to proactively hire new coders rather than waiting for current staff to leave and replace them. Hiring coders in advance allowed Allina Health to train new coders and familiarize them with the organization’s workflow.

Bower-Jernigan estimates that it can take a year to properly train an inpatient coder, six to nine months to train an outpatient coder, and three to six months to train a clinic coder. To make the training process as smooth as possible, Allina Health created a Training Hub, a unique training program that matches veteran coders with new coders. New hires are told about Allina’s Training Hub, and the process that goes with it, when they are first interviewed for a position.

“For the new coders, boy, it’s very intimidating, because everything is new,” Bower-Jernigan says. “So we feel that if we can get them well educated in the interview process and how the training takes place, it helps prepare the process of the training itself.”

The Training Process

In advance of hiring new coders, Bower-Jernigan queried her own staff of coders for volunteers to be trainers who would work one-on-one with new coders and help develop training materials. She required that potential trainers have good communication skills and high productivity and quality levels. Additionally, trainers need to have a positive attitude so that new coders feel like they’re in a safe, welcoming environment. Coders that volunteer to be trainers spend 50 percent of their time coding and the other 50 percent on training. This ensures they don’t lose their coding skills, Bower-Jernigan explains. She also worked with Allina’s Human Resource department to offer additional incentives to trainers.

Most of Allina’s coders work remotely from their home offices throughout Minnesota and Wisconsin, but they start their training at the corporate location. Once the trainer and trainee are both on-site together, they focus on coding specialty sample charts together.  All sample charts are actual cases already coded. A coder is then audited in that specialty (with some actual uncoded and coded accounts) so there is confidence with the outcome of accuracy once the coder is released to code on their own for that specialty  Either way, a claim is never sent out without a trainer’s review. Once a trainee has demonstrated that they can navigate an electronic health record (EHR) and abstract correctly, they can go home. The majority of the rest of training can be completed by e-mail, telephone, and occasionally on site as needed.

Bower-Jernigan and her staff do their best to match a trainer’s teaching style to a coder’s learning style, even if it takes a few times to find the right pairing. To help ensure this is the case, the trainer and trainee have weekly conference calls with a coding manager for training updates. At the end of the call, the trainer hangs up so that the trainee can express any concerns with the training process to the coding manager. This gives trainees the opportunity to say, “I am struggling in this area,” Bower-Jernigan says.

“Our program for our training is really solid. I can tell you that when they complete their training we’re relieved and very proud, but we feel very good that they were given the tools to be successful. “After  that, it’s up to them to provide great quality and productivity. I believe it is the responsibility of management to create and provide useful tools for staff. We will continue to use this process for ICD-10 coding because it has ended up being a really positive program for the trainee, the trainer and management,” Bower-Jernigan adds.

Tips for Success

Bower-Jernigan says that partnering—or even having a good relationship with HIM schools and educators—can help improve training efforts. She says that when her training program started, she was finding that new coding graduates weren’t quite as prepared as she would’ve liked. Since 2009, she started inviting Twin City-area and greater Minnesota educators together for meetings once a year to talk through some of these issues.

“There’s huge value in working with the educators within your community and partnering with them to identify what’s working really well with the newly graduated student on who we get versus where there’s opportunity in the classroom setting,” Bower-Jernigan says.

To make sure training is working, Allina Health has created a homegrown web based tool to help measure productivity. Since the coders work mostly off-site, they have monthly call-in meetings, as well as on-site education and teambuilding activities four times per year.

“When people take the job, they understand they are going to be home,” Bower-Jernigan says. “And once again it has a lot to do with when you have an interview they understand what that means. All of us have different personalities and work ethics. Some are fine being completely alone at home. And for others that can be harder. That’s the way we are as people.”