What It Takes to Get to the Top

What It Takes to Get to the Top

National Advisory Board (NAB) members share their healthcare career stories.

One often heard frustration in the coding world is: “How do I get a job?” You’ve finished school, classes, bootcamps, etc., and now you have your official certification in hand. Shouldn’t that be enough? I asked that question 10 years ago.
Rewind 10 Years
I was a stay-at-home mom and went to school for a year, taking medical terminology, coding, and other medical business-related classes. Nothing could stop me, or so I thought. I had a passion for medical coding and was ready to show the world. I became certified, but I had no experience. No one seemed willing to take a risk on me, so I went back to school just for the internship. As a student, I had to ask for help. At that time, AAPC’s Project Xtern program didn’t exist. I went to an advisor who made a phone call and soon thereafter I was working in a coding department 20 hours a week (after classes and for free). Even after eight weeks of proving my aptitude, there was no place for me.
I still had to work, so I got a job in a patient financial services mail room. Three months later, a data entry job opened up and I grabbed it. I did that for about six months and was right in line when a coding position became available. I went from school to a coding position in one year. Looking back, it seems I was lucky and things just moved along for me, but let’s take a closer look.
I Started at the Bottom
It may seem like everything just fell into place for me, but here is how I got ahead in my career:
Humility – I swallowed my pride and worked in the mail room to get my foot in the door.
Openness – I was open to working in data entry until something better came along.
Willingness – I was willing to do whatever it took to get ahead, such as attending chapter meetings after work, networking, and corresponding with teachers, classmates, and employed coders.
These characteristics have really helped me get to where I am today. Once I got the coding bug, it was all I wanted to do. Auditing and education never crossed my mind, but I was willing to take on new challenges when presented with them.
I Give Back to Provide a Message
Today, I audit and educate providers and new coders, and I love it! Every year, I go back to my school to speak with students about breaking into this business. I also speak at and attend chapter meetings. This is what I hear from students and what I tell them:

  • “No one is hiring.” – Perhaps you have your sights set too high. You may need to take a low-level position to get your foot in the door. Remember: Internal applicants typically get preference when new jobs open up.
  • “I can’t afford a lower paying job.” – This is often the case for would-be coders who are making career transitions. Unfortunately, you may have to tighten your belt for awhile. Staying dedicated to your dream, connecting with people, working hard, and exuding excellence will move you up the career ladder.

How Other NAB Members Broke into the Field
Many members of the NAB began their careers in non-healthcare fields, while some started out knowing they had a passion for healthcare. Either way, they all started at the bottom (sometimes even taking on two jobs), looked for openings, and worked hard to get where they are today.
Rhonda Zollars, CPC, CPC-H, holds a position with the State of Arizona Office of Inspector General. She started working in a practice’s front and back office, moved on to referrals, and went on to coding (out of necessity) to resolve issues with a billing company. Zollars’ advice to new coders is “to take any position in the medical field and see what doors open once you are in … life will throw you curves and you can swing with them or give up. You need to decide what your future will be, and remember it’s a road you need to travel, even if it gets bumpy. Do not give up if this is the field for you.”
“You need to decide what your future will be, and remember it’s a road you need to travel, even if it gets bumpy.”
Nancy Clark, CPC, CPC-H, CPB, CPMA, CPC-I, took a more nontraditional path. Working in accounting, she wanted to expand her skill set to include medical accounting. As this specialty did not exist, Clark researched and discovered medical coding. “To this day, I find the medical coding career an even more challenging and rewarding profession than accounting,” Clark said.
“To this day, I find the medical coding career an even more challenging and rewarding profession than accounting,” Clark said.
Ida Landry’s, MBA, CPC, healthcare career happened by accident. In the mid-1990s, she fell into some hard times while working as an administrative assistant for the accounts payable department at Nike. A new hire, who Landry had helped to land the job, noticed and asked her if there was anything she could do to help. When Landry told her she needed a second job, the new hire handed her a piece of paper with a name and number on it. “Call this person,” Landry remembers her saying. The person was a manager for an insurance company who was looking for part-time workers. At first, Landry was a little skeptical because the manager did not want to interview her or see her resume. The manager’s response when Landry asked if a more formal interview is needed was, “You work for Nike, right? That is a stand-up company, so I think we are good.” Landry started the next day and enjoyed her second job so much that she left Nike to work at the insurance company full time. She has never regretted her decision.
Landry, who is now director at Keen Home Medical, said, “I admit my start in healthcare was unusual. Since the mid-90s, I have done it all: charge entry, billing, posting payments, collections, auditing, and now negotiating contracts, compliance, and managing a division of a DME company. I have enjoyed every aspect of my hands-on education and love to pass on my knowledge to others.”
Michael D. Miscoe, Esq., CPC, CASCC, CUC, CCPC, CPCO, began with an educational background in electrical engineering. He served in the army as an attack helicopter pilot and entered the civil market as a quality engineer, auditing subcontractor quality systems. Miscoe left that position for a software company startup and designed a medical billing software program. That led to his involvement in medical billing. Because medical policies and billing guidelines were not well published at the time, Miscoe performed extensive research into billing rules, coding, and medical policies, which started his career as a compliance consultant — initially, as adjunct service in support of software sales, and ultimately, as a sole focus area of the company. From there, he audited, lectured, and published articles. He then began performing forensic analysis as an expert, which led to Miscoe joining AAPC in 2001. He became interested in the legal side of healthcare billing and compliance and attended law school from 2004-2008, and passed the bar exam. Miscoe holds several credentials, continues forensic analysis, and provides legal representation to providers involved in commercial and Medicare carrier post payment disputes and HIPAA OCR complaints following a breach. The last 20 years have been a fascinating journey of learning, Miscoe said, and far afield from where I started.
The last 20 years have been a fascinating journey of learning, Miscoe said, and far afield from where he started.
Cynthia Swanson, RN, CPC, CEMC, CHC, CPMA, wanted to be a nurse when she grew up. She pursued her goal and enrolled in an Iowa nursing program. The summer of Swanson’s senior high school year, however, her brother suffered a traumatic, life changing event: a C-7 spinal cord injury. He spent six months at St. Mary’s Hospital, Rochester, Minnesota, followed by another month at Craig Rehab Hospital. This experience confirmed a nursing career path was the right choice for Swanson. Although she wanted to postpone college to help with her brother’s care, her parents insisted that she finish her education. To be near family and friends, Swanson transferred to a college in Rochester. After graduation, she got her first nursing job at a 79-bed hospital in Kansas, working on a medical/surgical floor and, later, in obstetrics, labor/delivery. She went on to work at a 53-bed rural hospital in Iowa, where she performed utilization review, quality assurance, and discharge planning. Seeing a job posting at Blue Cross and Blue Shield led her to the insurance industry, where she performed Medicare claims processing, medical review, coding, auditing, fair hearings, and appeals.
During Swanson’s five years at Medicare, she gained valuable experience that led her to Seim Johnson, a CPA and healthcare consulting firm in Omaha, Nebraska. Here, she conducts chart reviews and education, presents for many organizations and professional associations, researches regulatory healthcare topics, provides litigation support, and assists practitioners with ongoing compliance efforts. After 25 years at Seim Johnson, “I continue to find this area of work to be rewarding and never dull or boring … I’m very fortunate to enjoy the challenges and variety of work I get to do each day,” Swanson said.
“I continue to find this area of work to be rewarding and never dull or boring … I’m very fortunate to enjoy the challenges and variety of work I get to do each day,” Swanson said.
Maryann C. Palmeter, CPC, CENTC, started working for a local Medicare carrier in claims. Here, she gleaned valuable information about Medicare reimbursement methodologies, medical terminology, anatomy and physiology, and Medicare policy. Palmeter worked her way up to suspended claims, which taught her why Medicare denies claims or suspends them for medical review. From there, she worked in quality analysis, auditing claims examiners’ work product. Subsequent jobs include teaching claims examiners, conducting provider education, management and supervised microfilm retrieval, and quality analysis.
Palmeter wanted to learn more, so she left the local Medicare carrier after nine years and took a 50 percent pay cut to learn the physician billing side of the business. She started out teaching physician regulations, E/M guidelines, and billing and coding for a multi-specialty academic practice plan. She then worked in follow-up and collections and provider education. When it was time to move on, she took a job as a compliance auditor, which led her to compliance manager and then associate director of compliance. Her current position is director of physician billing compliance.
“My first interview with Blue Cross and Blue Shield of Florida was for a telephone customer service representative.” Palmeter said. “I was not even aware of the position for which I was being interviewed (so naïve back then).” Palmeter was asked if she liked to talk on the phone. Her answer, “No, not really.” She wasn’t hired for that position, but was hired in claims instead. She and her hiring manager laugh about that years later. Palmeter’s tip to applicants: Always know which job you are applying for and the job requirements, at least.
Palmeter’s tip to applicants: Always know which job you are applying for and the job requirements, at least.

Melissa Tescher, CPC, CPMA, CEMC, is compliance and coding specialist, Willamette Valley Professional Services in Salem, Oregon. She has been in the coding field over 10 years, with the last six spent auditing physician documentation and providing education to practitioners, support staff, and coding staff. Tescher enjoys working one-on-one with physicians to ensure accurate capture of services provided. She also enjoys speaking and mentoring at her local community college and at Salem, Oregon, local chapter meetings. Tescher sits on the AAPC National Advisory Board.

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Renee Dustman, BS, AAPC MACRA Proficient, is managing editor - content & editorial at AAPC. She holds a Bachelor of Science degree in Media Communications - Journalism. Renee has more than 30 years' experience in journalistic reporting, print production, graphic design, and content management. Follow her on Twitter @dustman_aapc.

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