As an ICD-10 trainer, five years ago I was knee-deep in instructor-led training. The landscape was exciting and new, and it was exhilarating to be part of training the coding workforce on an entirely new coding system.
Fast forward and here we are, almost two years into ICD-10 – and now it seems like old news. Education budgets have been slashed back to their pre-ICD-10 low levels. My face-to-face trainings have been reduced to monthly webinars delivered from my home office. And probably most notable, in my view, the voices of novice coders trying to enter the workforce, which had been drowned out by the drone of experienced coders learning new skills, have once again become prominent.
Without a doubt, there is a disconnect between what potential coders learn in school and what they need to know to land their first coding job. In my work with novice coders, the one resounding concern they have is this: “How do I get a job without experience when most ‘entry-level’ coding jobs require at least two years of experience?” If you’re in a hiring position, I’m sure you’ve heard that question multiple times. Maybe you’ve even had a new graduate beg you to give them a chance and offer them that first coding job.
Eight years ago, I created the Coder Coach , a blog dedicated to “wannabe” coders. I wasn’t in a hiring position, but I could see that the gap between coding school and employment was insurmountable unless someone was willing to give new graduates a chance. I started networking with students at a local coding school and offered to speak to them on a monthly basis and give short presentations to help fill the gaps. My thought was, if I could give them more information than they acquire from their coursework and teach them buzzwords, hiring managers might see their potential and enthusiasm for their newly chosen career.
In networking with them, I found they had heard some pretty disturbing things from established coders and coding managers – things like “I don’t have time to deal to train you” and “this industry is too hard and I don’t have time to explain it to you.” We’ve all felt time crunches and how impossible it can seem to fit one more thing into your day. And while it is hard to learn coding, we can’t afford not to bring in new, enthusiastic coding professionals as the workforce ages and retires; after all, demands for this specialized skill are still on the rise.
Education versus Mentoring
If you are in a supervisory position, this is my challenge to you: find a way to work new graduates and novice coders into your organization. There is no such thing as a coder who can “hit the ground running.” Even if they have experience, your organization’s culture and specific needs influence how you code and collect data. You’re going to have to train someone anyway. Why not include a little mentoring on the side in order to entice them to stay?
Merriam-Webster defines education as “the action or process of educating or of being educated” and “the knowledge and development resulting from an educational process.” In other words, it’s what we learn in school and from taking classes. Training represents the skill, knowledge, or experience acquired by someone when they are able to act on that education. For a person to do that, however, they need someone like you to give them a shot, which is why I’d like to challenge you to become more than a hiring manager and become someone’s mentor.
If you’re like me, you cringe a little at the thought of being a “mentor.” Writing a blog and networking with coding students is one thing, but “mentoring” sounds like a huge responsibility. I mean, who has the time? I have a full-time job and a family, so how could I ever fit in time for mentoring? But it doesn’t have to consume you, and it’s possible to build it into the structure of your department.
Create Entry-Level Opportunities
Many facilities have multiple levels of coding professionals that allow for the acceptance of new grads as well as ensure a ladder of advancement for their existing coders. While it may seem difficult to train a pool of coders from the ground up, taking one or two level 1 coders under your wing at a time with the assistance of other coding staff will allow you to mentor new professionals. Some organizations start the coding career ladder at level 1 and advance them to level 2 or 3 coders. Level 3 coders who excel can become coding educators. The coding educators are there to do everything the meeting-laden manager doesn’t have time to do: conduct 100% coding reviews until a coder establishes a certain accuracy, address coding questions, and act as a go-between for you and the rest of your coding staff.
Practice with Supervision
Are you worried about new coders making errors that will affect compliance and reimbursement? Everyone must learn somehow. Think of resident physicians, who are given the chance to practice new skills, under supervision. The consequences of a mistake by a surgical resident may be more serious than a mistake by a coder, but again, we all must start somewhere to perfect a skill. If you can make it work, a 100-percent pre-bill coding review alleviates this issue. As you identify areas in which a novice coder is excelling, you can scale back the review only to those cases with which they are struggling. For example, I have one client who first clears her new inpatient coders on matters such as small lengths of stay and low-dollar charts, while continuing reviews on more complex cases. Implementing coding practice with supervision provides critical educational feedback for the new coder, and it also prevents inaccurate claims from going out the door.
Let Someone Else do the Research
I’m sure you’re busy. Maybe you haven’t had time to read the latest U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) Work Plan. Are you concerned that you may have missed an important payer policy about which your coders should know? Do you have a stack of denials that you’ve been meaning to get to, but you aren’t sure where to start? How about letting your enthusiastic new employees start digging into those piles for you?
Sure, you can’t delegate everything, and they will have lots of questions, but there is surely something on your to-do list that a new coder could handle to gain experience while also helping you out. Not only will the new coder gain experience from these activities, but you will be grooming a more self-sufficient coder with good critical thinking and research skills.
Encourage Internal Advancement
Most managers tell me the same thing when I suggest they put time and effort into growing their own coders: why waste my time when they are just going to move on? “Lifers” are rare these days. Employee loyalty is tied more to an idea, concept, product, or person than it is to an organization. People who continue to do the same thing day in and day out don’t grow. Most Generation X’ers and millennials change jobs so they can continue to grow and advance. Why not help them advance within your own organization?
Pay it Forward
Think back on your own career. Who do you have to thank for helping you get your foot in the door? What did they do for you that made the difference and helped you advance?
As you think about that, it is my hope that you will find new and creative ways to help launch someone else’s career. The personal satisfaction that comes to seeing a mentee succeed is unmeasurable.
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Last August, the U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) reported its findings on a review of certain MS-DRGs
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