Hiring a coder should not be taken lightly. A coder will be responsible for translating provider services and procedures into appropriate codes to obtain proper reimbursement and be a key player in staying on top of compliance issues.

How can an organization ensure it is hiring qualified coding candidates? Follow this seven-step path to improve the chances of unearthing the best person.

Define Your Needs
To begin the hiring process, a practice must first determine its needs. Create a detailed job description that includes general and specific skills pertaining to your individual practice. Keep in mind that, much like physicians who decide what branch of medicine to practice, coders also can choose a specialty. A coder with experience in your practice’s specialty is more likely to be familiar with the specifics of that environment.

For example, a general surgery practice may not want to consider a coder who has only primary care coding experience. Or a physician practice may want to avoid candidates who have only facility coding knowledge.

Also consider whether the new hire should be familiar with a particular payer’s rules. Creating a job description that sets out clear expectations will go a long way toward screening résumés and drafting appropriate interview questions.

Look in the Best Places
Once the position has been defined, the practice must decide how to advertise the open position. There are many excellent options, ranging from notifying local colleges and national associations to posting on professional job search websites.

Local chapters of national associations such as AAPC and AHIMA are fertile ground for uncovering qualified candidates. It’s a pretty safe bet that coders who are active in their local chapters are invested in their careers and have a passion for the medical coding industry.

Other potential hires are closer to home. Evaluate existing staff to determine whether there’s someone with the necessary coding knowledge to fill the vacancy. Or perhaps there’s an in-house candidate who could transition into the position with a bit of additional training.

Don’t Discount New Coders
Local colleges offering coding and billing degrees are a good source of qualified coders. Many practices are apprehensive about hiring new graduates because the newcomers lack experience, but candidates just out of school often are still eager to learn and have the basics fresh in their minds. Many are even newly certified.

Remember, every coder was once a rookie. Mastery of the profession’s nuances comes with time and experience, but it is a skill that can be taught. Office processes and payer know-how change from practice to practice, so there is likely to be a learning curve with any new hire.

When considering new graduates, focus on their coding education and other skills important to the job. For example, there is a significant difference between a two-week course and an associate’s degree from a local college that includes a coding certification.

What ancillary skills does the candidate possess? Take into account attributes such as computer knowledge, organizational skills, personality, and the ability to work with providers, billing staff, and even patients. Hiring a coder with a nationally recognized certification, such as the certified professional coder credential from AAPC or the certified coding specialist credential from AHIMA, is often advisable. While certification is not a necessity and not being certified doesn’t mean someone isn’t a solid coder, a credential indicates mastery of at least the basics of coding.

Ask the Right Questions
The interview process is key when hiring for any profession, including coding. Ask questions to gauge coding knowledge and experience, evaluate complementary skills, and ascertain whether the candidate is a fit for your practice. The following are some sample questions to consider incorporating into the interview process:

• Are you familiar with Medicare and private payer regulations? If so, which payers?

• How do you stay updated on policy and code changes?

• What procedures have you most often coded?

• Do you have EMR experience? If so, did the EMR select the code or did you use the data in the chart to choose the code yourself?

• How many charts/cases do you typically code in one day?

• What is your average coding accuracy percentage?

• Tell me about a claim that was denied due to your coding. What happened and how did you correct it?

• Do you have a medical coding certification? If so, which one(s)? If not, are you planning to get certified?

Get Testy
To measure a candidate’s actual ability to code real-life scenarios, administer a coding test. Consider offering a short quiz solely focused on the type of cases seen most frequently in your practice. This will help determine the areas where candidates excel and where they need additional training if they are hired.

It also may be a good idea to create a 10- to 15-question quiz that incorporates CPT, ICD-9, and HCPCS coding. Include a few scenarios common to your practice as well as a few challenging questions that will test a candidate’s knowledge of topics such as modifier use, global periods, and correct coding initiative bundling rules.

Medical terminology also is important. Coders must be able to translate provider documentation that includes complicated terms and sometimes confusing abbreviations. A solid medical terminology knowledge base helps ensure proper coding, efficient production, and successful job performance. Some employers incorporate a quick quiz on terminology along with a coding test.

Verify Credentials
As mentioned earlier, coding certifications typically are a big positive on a coder’s résumé. As a result, it is always a good idea to verify any candidate’s certification claims. Ask prospective employees for their membership or certification number. Then visit the certifying entity’s website or call its membership department to verify the candidate’s certification is legitimate and current.

Guard Against Risky Hires
Along with checking credentials, practices should engage in a bit more sleuthing before hiring a new coder—or anyone for that matter. Contact at least two work-related references to verify the person’s previous employment information, including job performance and reason for leaving.

Because coders will be involved with both personal health information and the practice’s finances, consider performing an actual background check that includes credit history and any criminal activity. If that strategy is adopted, the practice must provide the job applicant with a written disclosure explaining its plan to obtain this information.

Also be sure to check the Office of Inspector General’s exclusions database to confirm the applicant is not on the exclusion list for unethical or illegal dealings with Medicare or Medicaid. (Visit http://exclusions.oig.hhs.gov to search the database.)

Source: For The Record Vol. 24 No. 23 P. 6/Author:  By Leesa A. Israel, CPC, CUC, CMBS