Finding the right medical coder

June 2, 2015

A good coder is integral to a high-functioning medical practice. Here's what to look for, where to find the ideal candidate, and how to confirm credentials.

Hiring a medical coder can be a difficult task, and should not be taken lightly. A good coder is integral to a high-functioning medical practice. This person is responsible to file claims correctly; given the many (and frequently changing) payer requirements, this is a challenging task. The consequences of failure affect not only your bottom line, but also your potential liability under the law.

 

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What to look for

Fortunately, finding what you are looking for in a coder can be easy, if you know a few things.

Begin by writing a job description that outlines what the coder is expected to do. For instance, in some offices the coder is only that - a coder. He does not enter charges, does not bill claims, and does not follow-up on claims. In other offices, the coder is responsible for every part of the claims process, from interpreting provider documentation and translating it into the appropriate codes, to data entry, to billing and follow-up on denials.

Related:Coding changes for 2015: New evaluation and management codes explained

Look for coders with experience that meet your needs. It is best to hire a coder who is certified, also known as a Certified Professional Coder (CPC). Not being certified doesn't mean someone isn't an excellent coder; however, a credential indicates mastery of at least the basics of ICD-9, CPT®, HCPCS, medical terminology and anatomy.

Depending on the needs of your office, you may seek additional, specialty-specific certification. For example, a cardiology practice may look to hire a Certified Cardiology Coder (CCC). Visit the AAPC website to learn more about specialty credentials.

As payers place an ever-increasing emphasis on regulatory compliance, you may wish to hire someone who holds a Certified Profession Compliance Officer (CPCO) in addition to a CPC or other specialty coding credential.

Additionally, you may want your coder to have experience working with insurance companies. This is an important point to consider because there are many, payer-specific rules and regulations.

A clear job description will go a long way in screening résumés, and to ensure that you ask the right questions when you interview a prospective hire.

 

NEXT: Finding credentialing organizations

 

Where to look

After you have clearly defined the position, you need to decide how to advertise the open position and to determine where you will find the most qualified respondents. There are several options available, ranging from notifying local colleges and national credentialing organizations to posting on professional job search websites.

Look in your own backyard, first. Is there a current member of your staff who is willing and able to earn a CPC credential? These candidates already know your practice, and can be a great investment.

Local chapters of national credentialing organizations, such as AAPC and American Health Information Management Association (AHIMA), can be valuable resources. It is a safe bet that most coders who are active in their local chapters are significantly invested in their careers, and have a strong working knowledge of the medical coding industry. These organizations will usually include a job search on their websites. These are a prime place for posting the jobs with very little investment.

Mastering coding takes time and experience, but it is a skill that can be taught. Local colleges that offer coding and billing degrees or certification preparation courses are another great place to look for qualified coders. Some practices may be apprehensive about hiring new graduates (due to lack of experience), but new hires just out of school most often are still eager to learn, and have the basics fresh in their minds. Many newly certified coders are experienced, but only recently decided to further their education.

Related:Coding association predicts a smooth transition to ICD-10

What other skills and attributes does the candidate have to offer? Take into account things such as experience with computer software programs, proven organizational skills, personality traits, and good communication skills. You will always encounter a learning curve with any new hire; processes and procedures vary from practice to practice.

Confirm experience and credentials

Be certain that your candidate can code real-life case scenarios. Consider offering a brief screening exam. Base the screening on types of cases and scenarios seen in your practice, most often. The coder will need to accurately select ICD-9 or ICD-10 codes, CPT® codes, and HCPCS, if applicable. This will help determine the candidate's strong areas, and where she may need additional training, if hired.

The candidate's knowledge of medical terminology and anatomy is also important. Coders have to be able to interpret a provider's documentation, which may include complicated terms, abbreviations, and references to anatomy. Consider incorporating a quick quiz on terminology and anatomy, along with the case scenarios.

Always verify a candidate's certification claims. Ask for his membership or certification number. With this information, and the individual's last name, you can verify AAPC credentials online.

Finally, check the candidate's character. A coder has access to extremely sensitive information, financials, medical records, personal information, etc. Consider doing a background check, and call an applicant's references, verify employment, and reason for leaving previous employers. You can never be too careful when considering who has access to personal and private information.

Jennifer Bartunek, CPC, CPC-I, CPB, is continuing education unit vendor department manager and a distance learning coach coordinator for the AAPC.