Although I understand your frustration with the job market, please look to the future.
As RACs and similar programs increase the scrutiny on medical claims for payment, I suspect coders will be more readily pursued--certified ones to be specific. Although I live and work in an urban environment, I'm sometimes amazed at the number of providers in the area who do not employ certified coding professionals; instead, they rely on CMAs, clerical staff, etc to support their coding. How these providers have managed to continue this practice is beyond me--as almost any place I have worked has promoted certification in its coding staff. The current atmosphere in healthcare will not permit these providers and their practices to maintain second-rate coding and billing much longer. Those practices without certified coders will have limited options: outsourcing billing and coding functions, continue to accrue financial penalties, combine their practices with competitors, attempt to certify existing staff or seek and hire already certified coders.
As with any career or trade, coding may require novices to leave their geographic area and move outside that immediate area. This is unfortunate, but I see that in a variety of healthcare occupations. You're right to pursue a "foot in the door approach". In the meantime, expand your skills and education; try to find a way of making your skills desirable to employers. I'd advise you to look into what coding vacancies require and then pursue gaining those qualifications yourself. Attend local chapter meetings and discuss your situation with Officers there; network and keep a positive attitude.
Be sure that your quest for employment stays positive--this demonstrates how you will work under pressure and in dynamic situations. If you can, volunteer your time with helping others or on committees at your local chapter level.
Good luck to you and know that the expectations payers are putting on providers, hospitals and other health care organizations can be of benefit to your career. Mold yourself into a marketable coder.
Kevin B. Shields, RHIT, CPCO, CCS, CPC, COC, CCS-P, CPC-P, CPC-I