Experience vs. Education: Which Is Best?

Experience vs. Education: Which Is Best?

Consider the pros and cons for either route and then set a course.

Students who enroll in an education program to pass a certification exam for a medical coding career often find difficulty obtaining a position without experience. Others obtain a job in the field to gain experience but lack formal coding education or certification. Who is better prepared to launch a coding career: those with an education, or those with experience? Is there a benefit to having one over the other? Consider the pros and cons of both.

Starting a Career

Think of the first job you ever held. Was it at the local fast-food chain while in high school? Perhaps it was working for a family member at their company. Or maybe it was fresh out of college, full of knowledge, with the big dream of making a fortune, only to find yourself in a mundane position not using any of that knowledge. Each of us has our own unique experience for entering the workforce.

As an educator, I often see students struggle to understand the concepts of ICD-10-CM coding — how to obtain the code or how to apply the guidelines for sequencing. I wonder where along their journey the knowledge gained will translate into skills. I was a self-taught coder thrown into the realm of medical administration with my first job as a physical therapy technician on the road to physical therapy school. However, the road forked when my application to school was declined, and I have continued in medical administrative roles ever since. I learned the complications of insurance rules, authorizations, and codes on the job. Over the years, many professionals I have met have had similar beginnings by answering phones and progressing up through managerial roles. So, experience is the best teacher. Right?

Learning on the Job

Learning from experience allows coders to become proficient in their current role. If a coder takes a job answering phones at the local dermatology office, they will become familiar with the registration process, patient protocol, participating insurance companies, and codes specific to that one office. This narrow experience can allow advancement to a certain level before additional skills, rules, and coding knowledge may be required. If the coder decides to move on to a new facility or their current practice merges with another practice, they may feel lost in an unfamiliar environment.

Experience, in this case, may limit skills and potential. The realm of outpatient physical therapy contains a few dozen CPT® codes and minimal guidelines, but there were over 200 new procedure codes introduced in 2022 alone. Specialties bring with them limited knowledge gained about the medical coding world as a whole. Insurance requirements in a specialty field are limited to plan coverage. Not all specialties are covered by all insurance plans, limiting coverage knowledge compared with other fields. Moving from one specialty to another requires learning new code sets, new processes, and new requirements. So, is a formal education the way to go?

Getting an Education

Education provides full-spectrum learning. A formalized education program — whether through a college, online organization, or AAPC directly — introduces students to multiple concepts seen in the medical coding world. Education and training will consist of learning all ICD-10-CM guidelines and coding concepts, reviewing medical necessity, applying CPT® coding and guideline concepts, and possibly a review of the CMS-1500 claim form. Education also may include the revenue cycle with information on national insurance carriers, plan types, specific requirements, and claim form processing. Some educational programs may even introduce ICD-10-PCS inpatient coding and billing.

Education can be overwhelming to some, though. The educator presenting the material may be limited by time or technology for proper comprehension of the material. Some students may be completing their education program while working full-time jobs and juggling families and schedules, as well. These unique factors can interrupt a student’s ability to focus and understand the material presented.

Making a Choice

Deciding whether to pursue experience or education is a personal choice based on comfort, preference, and resources. Education provides you with the entire puzzle — a view of the healthcare revenue cycle from start to finish — and this may ignite a passion in one area of the industry. Skills gained through education in a formalized program will introduce students to the full range of medical codes available for use and, therefore, may provide more job avenues once a degree or certification is obtained. But, for some, a full course can be overwhelming.

Skills gained on the job provide a new coder with a limited view of coding in general when working in a specialty, but this also builds skills and proficiency in that area. Once these skills are mastered, the experienced individual may choose to embark on their own educational journey to improve their skills and transition into other areas of healthcare administration.

There is no right answer to the question of experience versus education. Whether we begin in the field learning as we go or obtain education prior to breaking into the field, the uniqueness of the individual experience fuels the passionate journey on which we embark.

Jennifer Sanders
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Jennifer Sanders, MBA, CPC, CPB, CPMA, CPPM, COSC, CPC-I, CCS-P, AAPC Fellow, AHIMA-Approved Revenue Cycle Trainer, has been involved in the medical industry since 1992. Her passions are education, leadership, and revenue cycle management working as an associate professor, coach, instructor for AAPC, and consultant. She holds an MBA in healthcare management and serves as president of the Leonardtown/Southern Maryland local chapter.

21 Responses to “Experience vs. Education: Which Is Best?”

  1. Kathy DeArmas says:

    This article is spot on! You cannot put a price on experience but throughout my career, I have been limited in my options of growth because I lack a college degree. Everyone is presented with different opportunitis throughout their lives. My advice is to embrace each one but grab as many educational opportunities that you can. The earlier in your career that you are able to complete formal training, the easier it is to work and complete formal education at the same time.

  2. Stacie Dennis says:

    Love this article!! I could be the poster child of learning as you go and then getting some schooling in after the fact. I was working in fast food, no joke, had a daily customer that happened to ask one time if anyone was looking for a job. I said “who, what, when, where and how much”? I’d gone to secretarial school right out of high school, so I had the typing, filing, 10-key knowledge under my belt. So, I had an interview for a medical records position (this was back in 1994), got hired w/ no experience whatsoever. I had a previously planned vacation w/ my young daughter set so I let my employer know that when I get back from vacation I wouldn’t be back.
    While I was gone, I was notified that there was a position that opened up for “front desk” receptionist as the person that was there put their notice in. Of course, I jumped at the chance. I was a single parent so any chance of bettering myself I was going to take!!
    Fast forward 28 years later; I spent 17 years with two different family practices offices, (same office manager that hired me after only working at that fast food place), and have worked for a national radiology provider for the last 10 years. I obtained my CPB last year and am currently working towards my CPC.
    I LOVE what I do and truly enjoy working at the company I do. I am an insurance f/up specialist at the moment, but who knows what will come next.
    Moral of the story: Do what you love, work hard and never give up!!

  3. Renee Dustman says:

    Thanks for sharing, Stacie! Please consider sharing your experience with members by submitting an educational article or #iamaapc article to AAPC.

  4. Robert Charette says:

    I have been in the field for many years, I can tell you that getting you foot in the door is the most important. Then from there you expand. Knowledge is power. But experience pays.

  5. Karin Marsh Eliot says:

    This article really puts things in perspective for me and I needed that today! I am middle aged, starting fresh out of school with my CPC-A looking for a job and getting very familiar with the brick wall I have been hearing so much about You are correct, of course, in all you describe. I knew this from my years of experience but really needed to have this perspective of the industry spelled out. I will not give up! Thank you so much!

  6. Catherine Nilson says:

    Good article. I worked in various retail and customer service jobs before becoming a mother. Stayed home with my kids for years until they were school age. Then I decided to go to school for medical billing and coding, got my CPC. Actually, got hired in my current position the same week I passed my certification exam. It’s an entry level billing/PFS position, and I’ve learned a lot this past year on the job. Working on my COC certification currently and starting this fall on a bachelor degree in health policy and administration. Education has always been something I enjoy and I’m glad I had some knowledge before entering the field, but the job is what has helped me feel more confident in my abilities and figure out what direction I’d like this career to take me. I agree, there’s no right or wrong. We all have our own path that’s right for us. I am grateful for finding this field and hope to continue showing my kids it’s never too late to find your path and reach your goals. Thanks for sharing your experiences and insight!

  7. Paula Zoito says:

    Great article. I have always felt that education and experience go hand in hand. How much time you want to put into each, is up to the individual. A coder can have no experience at all, yet complete a course and receive a 98% on their CPC exam. Would I consider this person experienced? No. I believe the best coders have a mix of both.
    The education does not need to be formalized or a college degree, but could be something such as workshops, webinars, and maneuvering the Medicare website. Experience is something you gain with your job, and hopefully have the support you need to keep learning. In my current position as a lead coder, I will reach out to our coders and ask what topics of education they would be interested in learning. This way they are getting the experience and education they need to do a great job and have a rewarding career.

  8. Maria Blanch says:

    Well written and well said. I’m the type that always looks for “the paper” (Certificate). In fact, that’s what I’m doing right now, proudly an AAPC student working towards my CPC certification. I’m also the one looking for a job without the experience. I am willing to start at an entry level as I continue my studies. However, even jobs as front desk receptionist at a medical office require experience on the software used for scheduling patients. I’m trying to make a career change (former elementary teacher) and working hard towards it. If anyone out there is “listening” I could use some help!
    Thank you!

  9. Claudia Cocina says:

    Thanks for this article. Being a new coder myself ( on paper) with CPC -A but no experience, it has been really hard finding a job. Also with new things being added and deleted every year plus CEU’s, it takes a toll on you emotionally. I have to say that maybe having the experience first gives you more of an advantage vs. getting a chance as a new coder.

  10. Edna Silva says:

    Be ware! This profession is very expensive in both time and money! I’ve taken the certification tests and passed. The time I spent studying, the costs of books, study materials, membership can easily pass the $1k or $2k mark, each and every year. Possibly without working in that field. I have had to keep studying and keep up my CEU’s so I don’t lose my $20k investment.

  11. Marsha Briley CPC says:

    I really enjoyed this article. Thank you Renee. I too, was a learn as you go in the medical field. Additional knowledge came from schooling after I had been in the medical field for a few years and continued learning from classes offered. I obtained my CPC thru AAPC after 9 years of being a front office scheduler, learning about insurances, insurance authorizations, patient account representative, insurance denials and coding. So many opportunities had come my way over the years working in doctor offices, billing services and having my small billing company. As far as college, I attended a junior college for 2 years and not one medical class was taken. My recommendation is to get your foot in the door of the medical field first and of course, if you have college degrees that is a plus. Just make sure you like what you are doing before putting out any extra money to continue on with your schooling, certification courses etc. I feel bad for those who go to a school whose mission statement is guaranteeing an “Entry Level Position”. You can get that entry level job on your own without paying thousands of dollars spent on that school. There are so many positions in the ‘medical field” now. I have been retired for close to 8 years and it always amazes me to see all those who have achieve their goals and those who are striving for their first certification or continuing their education. You got this!

  12. Edith K. Ballard, MHA, MBA, MsHIM, RHIA, CCA, CPC, COC, CRCR says:

    I know that skill, experience and education the three cornerstones to excelling and reaching the highest levels of career opportunities. So, it depends upon were you would like to take your career. It’s an individual’s choice to make.

  13. Evelyn Navarrete says:

    Great article! Unfortunately, I took a coding program and passed AAPC coding exam, but everyone wants experience.

  14. Julia Stinson says:

    I enjoyed your article. I have worked in healthcare for 29 years as an LPN. My work experience has crossed over into coding and billing numerous times and so I decided to transition from nursing to coding or billing this past year. I took a billing and coding certification course and did very well. My job hunting has not been so successful. It has been frustrating because I have not actually worked in billing or coding just have knowledge due to my nursing experience. I will keep applying and I am sure something will happen I just have to be patient. So I do feel work experience does count for a lot in this field. This was a good read.

  15. Renee Dustman says:

    Maria, Try AAPC’s Facebook page to start up a conversation with fellow coders.

  16. Maria McDonald says:

    I really love this article, I started by someone giving me a chance with no experience in a specialist medical practice, gained the experience and then went on to college got my degree and got certified as a CPC, CPCO and now currently hold 6 different certifications from AAPC and AHIMA, so it pays to have both education and on the job experience. I got hired as a coder first then promoted to compliance analysis, and fast-forward I am now a manager over coding, billing and education, goal is to get my MBA and be a director, salary also increased generously, so it pays off, don’t give up, keep learning and pushing yourselves.

  17. Elodia Fernandez says:

    Great article and makes you think were should I start? I was very fortunate to have someone show me the basics about billing. I loved it and best of all I understood what needed to be done and hit the floor running with it. It taught me so much about billing that I was an expert on sending out that clean claim. I wanted that certification too, I tried a couple of times and kept missing by a couple of questions. I was self taught, and that’s where having that formal training would have been beneficial for me to get the whole picture all at once. Years down the road, I finally got it and put it all together. These days having that certificate will open doors quicker as there are jobs for students who just received their cpc certificate. I have enjoyed the long journey learning from family, peds, oncology, gi, neurology, ent, cardio and this has gotten me to where I am currently a coding auditor.

  18. IBIRONKE NGOZI ONUNAKU says:

    Knowledge is a key factor that will eventually lead to being experienced. Education and experience go hand in hand to be able to go forward . When you are on the job training, you are acquiring knowledge or education to better understand that which will lead to being successful in what you do.

  19. Dr. Alvi says:

    I am a Medical doctor with degrees like MBBS, DGO, B.Sc honours in chemistry, Alternative medicine Hijama certified and now CPC certified by AAPC ….the ultimate truth is that if you do not have experience you cannot work anywhere…it’s a year now since my CPC certification but no job yet , everyone wants experience. I think we need in to make some changes in this education system where you bridge this gap of experience.
    Institutes should provide this intial experience even if it is unpaid.
    Bottom line both education n experience go hand in hand and if you are lucky enough you strike gold and if not one you can keep trying your luck spending money to get certifications and then try again your luck . Best of luck !

  20. Mahalia Simmons says:

    I believe that experience is more important than education. I had a degree and education in coding and billing but, had no experience and it was hard finding employment. I had to literally volunteer at a coding company to gain experience in order to find my first job in the field.

  21. Suzanne Batz says:

    I think education is key. It gives you a more rounded picture of what coding entails,

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