Hire and Retain Excellent Coding Staff
Part 1: Finding the right person for the job takes more than luck.
By Pam Brooks, CPC, CPC-H
The job outlook for coders is good, according to U.S. Department of Labor statistics. Due to an aging population and an increase in insured Americans (compared to past years), the field is expected to grow as much as 21 percent. Coding is an attractive career option offering a professional environment, interesting work, and a median salary of $48,593 (AAPC Salary Survey, 2013). This should make it easy to find bright, talented, and enthusiastic coding staff, right? But as a hiring manager, I can tell you that finding good employees requires strategy.
Author’s Note: In this three-part series, we begin with a look at how to find accurate, efficient, and enthusiastic employees. In future installments, I’ll share tips on how to keep exceptional employees and how to improve the staff you already have. If you’re looking for a job, or looking to improve your current skills, you might pick up some tips, as well.
Set Expectations with the Job Description
You cannot expect to hire the right person unless you have a clear description of what that person’s job responsibilities will be. Ask for what you need, and be straightforward in how you ask for it.
Job descriptions include duties and tasks that are day-to-day assignments. For example, the job description might read, “Using CPT®, ICD-9-CM, HCPCS Level II, physician documentation, and other approved resources, to assign procedure and diagnosis codes, and modifiers, to all professional services.”
The job description also outlines responsibilities, which include all activities necessary to meet a particular need (e.g., “Serve as a definitive resource for physicians and administrative staff relative to technical guidance on professional coding issues.”). Tasks (e.g., training, auditing, educating staff and providers) should be based on the overall designated responsibility of the person in that position. That way, as tasks change, the responsibilities remain part of the job description.
Make sure the job description states all standards, guidelines, and expectations. This is how you can measure your employees’ work to quantify their success. For example, the job description might read, “Code with 95 percent accuracy as evidenced by quarterly external and internal audits.” This gives you metrics to support discussions regarding process improvement.
The job posting also should state education requirements. For example, you may require post-secondary coursework in anatomy, pathophysiology, and medical terminology, as well as coding certification or a bachelor’s degree. Do not settle for an under-qualified individual, unless you are willing to provide the education necessary to bring him or her to the required level. You can’t expect staff to learn without training, or to train themselves (even if you provide the tools). If you have the resources to train new coders, you can eliminate education requirements.
Aim High to Ensure Success
The job description should enumerate a candidate’s expected skills. For example, you might require “the ability to understand healthcare insurance guidelines as relative to correct coding initiatives,” or “experience in working with multiple reports, graphs, and spreadsheets in Microsoft Excel.”
If these skills aren’t present, existing staff might be able to train and mentor the new employee; but if your staff is already overworked and pressured, they may resent supervising a newbie. Don’t set up your new employee to be viewed as an inconvenience for everyone else. Set the bar high and make sure your job applicants have the necessary skills from the start.
Keep in mind: Listing required skills as part of the job description means existing employees must possess and maintain those skills, as well.
Prioritize Your Needs
Lack of experience can eliminate capable candidates. Consider what’s more important: time or talent? If the job requires solid evaluation and management (E/M) coding experience, for instance, you’ll need to hire someone who already possesses that knowledge. But if the position requires a specific skill set — such as being able to train the adult learner, data entry, or understanding financial reports — you may want to hire someone with less experience, as long as he or she can demonstrate the skill set.
After you’ve outlined the job description, consider the personality, appearance, and communication skills of the candidate. In composing a job posting, illustrate the kind of person you’re looking for. Use language from your organization’s mission, vision, and value statements to attract people with the same philosophy.
Where to Look
Posting to job boards, such as Monster.com, will likely attract a wide range of applicants. If you need a specific skill set, it’s better to narrow the focus of your search. For example, if you need entry-level staff, contact your local coding or billing school and ask the program director for the name of their top student.
Sometimes, you already know who you want to hire because you’ve met him or her at an AAPC local chapter meeting. Likewise, attending job fairs can arm you with names and resumes of people in your area who are actively seeking work. You can even perform preliminary interviews on the spot.
For positions requiring specific or advanced skills, you can find candidates using resume searches on sites such as LinkedIn. A recruiter or headhunter can also help you locate talented, experienced individuals. The cost of the search might be worth the results. It also never hurts to recruit an employee who’s working elsewhere — particularly if he or she is doing the kind of work you need.
Sorting Through Resumes
Not all resumes are outstanding. If candidates don’t follow application directions, disqualify them. Look for poor formatting, misspelling, and grammatical errors. Anyone who makes a mistake on his or her resume likely won’t be meticulous working for you. Watch out for email addresses that might reveal the personality of the applicant, as well. You may not want to hire firstname.lastname@example.org, for obvious reasons.
A good resume should contain demographics, including the applicant’s name and credentials on the header. A job objective is a nice feature, but if you have a prospective employee’s resume, it’s probably safe to assume that his or her objective is to obtain a job from you. Education, certification, and skills you’ve noted in your job posting should be clearly outlined.
A high-quality resume also lists experience in the form of outcomes. For example, the resume may outline what the prospective employee has done to make a difference in previous positions. Simple lists of job duties are often irrelevant, and tell very little about the applicant’s skill set.
Look for dates of unemployment, and don’t hesitate to ask what the applicant was doing during that time. If a candidate was unemployed for a long time, that’s not necessarily a deal-breaker. Find out if and how he or she was otherwise occupied, such as being in school, working as a volunteer, or being a full-time parent.
What to Look for During Interviews
Almost everyone looks decent on paper, as long as he or she meets your basic job criteria. Hiring managers have to dig deeper to pick the best candidate.
Start with a quick phone interview to begin weeding out individuals who don’t meet the requirements, who are looking for something outside of what you can provide, or who may not qualify for a more time-consuming onsite interview. It’s better to learn these things in a phone interview, rather than to find out in the first five minutes of an onsite interview. If you’re happy with this initial contact, schedule an onsite interview.
The onsite interview is the candidate’s first opportunity to sell his- or herself to you. Is he or she on time? Does his or her attire satisfy your dress code? Is the candidate prepared to supply you with documentation of his or her certifications, education, and references?
A prepared candidate has researched your facility so he or she understands the kinds of services it provides. The candidate should:
- Have read the job description and come with good questions such as what a typical workday would be like
- Have an eye on the future and a five-year plan to briefly discuss with you
- Be willing to adapt to change and learn new concepts
Because you want all employees to be successful, you need to know and should ask, what tasks the applicant is not willing to do.
Behavioral interviewing is helpful to gauge how people will perform on the job when faced with certain situations. Ask thoughtful questions, such as, “Tell me about a time when a colleague created a problem for you.” What you want to hear is that the applicant was able to work it out with the colleague. Also, ask the applicant, “What would happen if I asked you to do something you didn’t agree with?” This gives you a bit of insight into how she would handle ethical dilemmas.
Set a 15-20 minute time limit for the onsite interview. If, after that time, it’s evident the applicant isn’t appropriate for the position, end the interview and politely tell the person that his or her skills don’t match your needs. Follow up later with a polite “Thank you for applying” email. Other courtesy options include offering to forward the applicant’s resume to other employers and providing constructive feedback about why you couldn’t hire the candidate.
If several applicants have similar job qualifications, the decision may be a matter of who appears to fit most comfortably with the existing staff. It may be helpful to involve the rest of the team when interviewing a potential hire. This can be stressful for the candidate, and time consuming for staff, but it also gives staff some ownership in the new employee’s success.
Tell Candidates about Background Checks
Inform potential new hires of any background checks you intend to make. If you accept federal money (e.g., Medicare), you must make sure your candidate is not on the Office of Inspector General’s (OIG) exclusion list. Other background checks might include a Social Security trace, a criminal record search, employment history verification, a search of the sex offender registry, and AAPC certification verification. Alerting the candidate in advance allows him or her to give approval (which you should get in writing), and to back out gracefully if any of these searches would uncover something embarrassing.
You might also check LinkedIn, Facebook, and Twitter, and perhaps perform a Google search. People have a right to their personal lives, but you want to identify any candidate whose public image is racist, inappropriate, or vulgar. This is also an excellent opportunity to discuss your company’s social media policy.
Many organizations also require a pre-employment physical and drug testing. Inform your candidates of these requirements if they are a requirement of employment.
Pre-employment Skills Testing Done Right
Testing can help you determine which candidates have the most knowledge of a particular coding specialty or skill. Some coding functions, however, are open to interpretation, such as E/M coding, and may not provide an accurate picture of the candidate’s skill set. Use testing only if it’s critical to evaluate the candidate’s ability to do the job, and only if you can provide full access to his or her real work environment.
To be fair, provide candidates with the tools they would need in their everyday work environment. Failing to replicate the workplace in a test situation places the candidate at a disadvantage, and prevents you from getting a clear picture of his or her skill level.
When you have several solid candidates, it may be helpful to pull their information together into a spreadsheet where you can compare their skills, experience, and other qualifications. Note any comments you made, concerns you had, questions that candidates handled particularly well, and the candidates’ availability or other logistical issues (such as commute time). Pay attention to applicants who took time to thank you for their interviews. This comparison allows you to pinpoint the candidate who rises above all others.
Pam Brooks, CPC, CPC-H, is the coding manager at Wentworth Douglass Hospital in Dover, N.H. She supervises a staff of multi-specialty coders and developed a team of medical auditors and educators, surgical specialty coders, and documentation improvement specialists. Brooks started in a mental health billing office and moved into management of an eating disorders practice. She earned a Bachelor of Science degree in Adult Education and Workplace Training from Granite State College and is completing a master’s in Health Administration from St. Joseph’s College, Maine. Brooks is a member of the Seacoast-Dover local chapter and sits on the AAPC Chapter Association board of directors, Region 1. She is a frequent contributor and speaks throughout New England and nationally regarding coding and career development topics.