I think it depends on the type of position you are trying to fill.
I have a very unofficial coding exam I give the top 2-5 candidates following interviews. I literally redact 8 office notes and 2 surgery notes. No multiple choice. Real world is not multiple choice. Candidates get a grid to fill in any CPT with mod, ICD10 and comment. I tell them they have 1 hour. Stop at an hour, even if not completed. And then I DISCUSS their answers with them. So almost like essay questions with partial credit. Honestly, I do not expect any of these candidates to know and properly code (without multiple choice) a laparoscopic hysterectomy with sentinel lymphadenectomy and debulking. But I expect them to not pick codes from open procedures if done laparoscopically. I personally look for candidates who understand coding CONCEPTS who I can then train in our specialties/subspecialties and computer systems.
I generally hire people who are fairly entry level and am willing to train. For some positions, you may need someone who can hit the ground running day 1.
In my opinion, as long as you are matching the salary to the expected knowledge at hire, there seem to be candidates out there at almost every skill level, especially if remote.
If I recall correctly, you work in radonc. If you are looking for a candidate who already knows radonc and not remote, you are severely limiting your options. I personally would rather spend a few weeks incorporating radonc knowledge to someone more entry level who already understands E&M leveling well than someone with possible bad habits in radonc. I do look for people with some type of relatable experience and a willingness to learn. CPC-A who also worked front desk. CPC who worked derm for 1 year and looking to expand knowledge.
Here's my full process for remote hiring:
1) Ad - be specific in what I am looking for. Provide salary range. Provide work hours. Specify what certifications I will accept. List what states they must reside in (requirement by my employer to only hire from specific states.)
2) Look over resume to ensure they are certified and have some type of relatable experience. No software review of a resume. Look with my own eyeballs. I will forgive ONE minor typo. Send an email asking them to call me if they meet requirements.
3) On 2 minute call, remind of salary range, work hours, state requirements, and basic job requirements. Confirm certification (I only accept from AAPC or AHIMA). If everything is good, schedule interview.
4) Initial "speed" interview via Zoom or other video app - 15 minutes MAX. I book 3/hour and hit a handful of items. Let them know job responsibilities in broad strokes. Ask a few coding questions to assess their current knowledge. There have literally been some interviews that I have cut short - tell them I don't intend to be rude, but their current skills are not what we're seeking for this position and don't want to waste their time.
5) Determine the top people from those interviews to give coding assessments to. Depending on how many people clicked, sometimes only 2 candidates. Sometimes 5. But if I did 40 initial interviews, I don't want to waste their time or MY time giving assessments. Almost everyone who took the coding assessment gets a second video interview scheduled for 30 minutes (could last 10, could last 45).
6) That second interview starts with a discussion of their coding answers. If I'm not pleased with that discussion, the second interview stops there. If we have good interaction, I complete the remainder of the 2nd interview. Discuss their background and experience. Delve deeper into responsibilities. Discuss their remote experience and/or setup. Allow them to ask any additional questions.
By this time, I usually know who I really think is a good fit. Yes, it is time consuming for me personally to do this. Yes, it is time well spent.
Good luck!
, currently in a private oncology practice. I'm also very lucky in that I have two very experienced coders now who have a combined 42 years in oncology coding and billing and both are certified.