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Unreasonable expectations? - Frustrated

Posted: Nov 05, 2012

Am I being unreasonable here? I have been an acute care MT for almost 15 years, spent the last year and half learning coding, coding increasingly complex cases, working towards certification. I am having a hard time with the concept of getting certified and then only being able to find a job doing billing in a doctor's office at $13 an hour. I feel like I would be taking a step backwards, like I have all this inpatient expertise, and I would be billing URIs and primary care visits. The reason I became an MT is because I like learning new things and it is challenging, and so maybe I should stay in MT until I can find a real coding job. I know coders on here have suggested to take any job to get your feet wet, but really, if I can't find a hospital position, take any office job I can find? Maybe I am not seeing the whole picture or don't have enough perspective to make a good decision. Should I swallow my pride and take a step backwards? I know it would not be forever, but is it really going to get me where I want to go, which is inpatient coding? I do have a bachelor's degree and want to work towards the RHIA as soon as I can afford it, in the next year or so. But for now, I'm not sure which direction to take. I am going to take the certs next month, so that's what I'm focused on, but still looking for job openings.

My opinion - sm

[ In Reply To ..]
You seem to be assuming the worst. I am not sure you need to do that.

If you were not working at all, yes, I would say to take any job you can get.

If you have a job, then you could continue wth it while trying to find a coding position that you like.

You are making two mistakes, though. One is in assuming that a physician services job is not worth your time. In fact, you can probably learn a lot from it. Many highly paid coding consultants work with doctors to improve their ability to get paid what they deserve for their services. But, I can see that the drop in pay would not be good.

The second is thinking that starting at the bottom would be an insult. In reality, nearly everyone who changes careers has to start over from the bottom. Your MT experience is valuable but does not count as coding experience. The advantage it gives you is not in where it lets you start, but in gettting up to speed quickly and advancing faster and farther than you would without it. It will help you do a better job and THAT will translate itself into money.

Do not worry about this until you see how things play out after your exams. I would offer one bit of advice. It is to be careful in what you say about your MT experience. Some employers may not feel that your MT experience is very relevant. You might do better if you avoid giving the impression that you think it is.

Thanks for the advice - OP

[ In Reply To ..]
I am glad to hear your opinion, thanks for giving it. I've been sitting here thinking about this and decided to keep on as an MT until a hospital position (any related job, not necessarily coding) opens up and to be picky, not taking just any job. I have worked in a doctor's office before, front and back office and learned some of the billing, what's involved. I just know I don't want to do that. I do appreciate the advice about my MT experience and how it's viewed by potential employers. Working at home, it's easy to lose touch with what's happening in the healthcare field. It will be good to be out in the workforce again.

Inpatient - coding

[ In Reply To ..]
Try to get in at a hospital. Hospital coding that can lead to IP coding includes ERs, Radiology, Physical Therapy, Occupational therapy, straightforward same day surgeries, even observation or short stay charts. Get your CCS. If the hospitals donâ��t have any openings, ask if they would hire you per diem to help out wherever they need in coding.

To frustrated re expectations - Anonymous

[ In Reply To ..]
First, what inpatient expertise are you referring to? MT experience, other than medical knowledge, means nothing in the coding world. I was an MT for more than 30 years before making the switch, and the people I work with really don't care what I did in my past life. The coding you did in school is not what you will encounter on the job. I posted below and suggested considering coding related and health informatics positions if you don't land a hospital coding job right away. BTW, very few RHIAs work as coders. In today's job market you will not be able to pick and choose. Once again, I am going to advise you to think outside the box and consider doctor's office jobs (you can negotiate a higher salary based on your education; also look at the benfits when you consider your total compensation), coding internships, abstracting jobs, analyst jobs or clerk jobs will all give you non-MT work experience. As someone else stated, no one stops at the top. Hospital coding jobs are sometimes classified as coder I and II based on years of experience, so don't expect to go into a hospital making top dollar either, they have a salary range just like everyone else. Be patient and open yourself up to new learning experiences. And yes, you may have to swallow your pride.

Oops - Anonymous

[ In Reply To ..]
Grammar alert, I should have said "no one starts at the top," not starts, sorry.

This is good advice - Been there

[ In Reply To ..]
That is very realistic advice. As has been noted before on this board, you may have to be careful not to fall into the MT tendency of thinking of coding as just one job. MT is just one main job and stagnant salaries. Coding is one of many related jobs with potential for lateral and upward moves. You might have learned coding but what you learned is a step toward many different jobs. There are many salary steps in your new field.

There IS a big difference between school coding and actual work. You will be surprised how much you still need to learn and how long you will be learning. It takes about 2 years to get a handle on the job. Employers know that, too.

Negotiating a higher salary based on what is not coding experience may not be realistic. It would be like a new accountant expecting a higher salary for experience as a bank teller . . . both jobs involve money but experience handling it is not the main thing. Coders are hired based on their ability to CODE and solve coding problems and make rational decisions to resolve new situations related to data and revenue needs.

I would not mention having years of experience with A&P. While this knowledge is a necessary base for coding, it is not the main thing. being able to use a computer is important, too, but is something you are assumed to just HAVE. Claiming years of experience in typng is not going to get more than a "so what" response. Claiming years of experience in med terms or A&P will get the same response. They are not hiring you for THAT.

You also need to be careful because your knowledge of A&P might seem extensive to you, but it is only a small fraction of what physicians learn in medical school. Even if you knew that much, it would not qualify you as a coder any more than it qualifies doctors or PhD anatomists as coders. Trying to sell yourself based on the A&P experience MTs have is going to make employers think you do not understand your job at all. A physician will just laugh at you.

You have to sell yourself on your coding abilities. You have to get that experience. Anything in HIM will give you relevant work experience, but only coding will give you coding experience.

Misunderstood - OP

[ In Reply To ..]
Maybe I stated my intentions wrong. I would not go into an interview and try to impress upon a potential employer my extensive A&P knowledge from years of MT. I realize that MT is not coding, but in MT, I have access to more advanced medicine than working as a biller. It would be hard to go to a billing job as a first step to coding, leaving all of my acute care experience behind, that's all I was trying to say. Seems like a waste to let that all go, taking a side step to billing on my way to coding. I just want an entry level outpatient coding job in a hospital or affililated facility so I can work my way up. Not sure if billing in a doctor's office is going to help me get into inpatient coding, but if necessary, I will do it.

try this place - see link enclosed

[ In Reply To ..]
http://intermedix.com/careers/

Lots of jobs I could get - just not in my state

[ In Reply To ..]
Thanks for the link, maybe other posters can qualify for these jobs.

that one is home based - did you see it?

[ In Reply To ..]
says Colorado but is home based? but maybe you are needing to work in house to gain experience and I understand that.

Since I don't have any experience - I would feel better inhouse

[ In Reply To ..]
Thanks, though, appreciate the link. Great to know there are some jobs out there.

Yes, but . . . yes, but . . . yes, but . . . - The view from here

[ In Reply To ..]
Who said you had to do billing in a doctor's office? I don't remember seeing that. And why would you assume that coders in doctors' offices are only doing billing? And why would you assume that working in a doctor's office would not help you get a job in inpatient coding?

And what state do you live in that has no coding jobs? Based on what? Where are you looking?

There is a pattern to your thoughts about this. You seem to feel you are too good for half the coding jobs out there, but when someone tries to help you see the reality of the job market, i.e., that you won't be wasting your extreme talents regardless of what job you get, you start "yes, butting." Yes, but you want to work in inpatient. Yes, but there are no jobs in your state. Yes, but you wanted to work in-house.

Here is the reality . . . there is nothing wrong with office coding and those jobs are not just billing. You can learn a lot from them and what you learn can be very useful. Any coding job will give you necessary experience. Many, many inpatient coders got there from outpatient coding.

There are no states that do not have doctors or hospitals, so there are no states that do not have coding jobs. Coding is not like MT in the way jobs are structured or advertised, so it is inadvisable to assume that there are no jobs beyond those you see online. As we have said many times before, you need to network with other MTs to learn about local jobs, whether they are in offices or hospitals. Many of them are not going to be advertised anywhere . . . they are filled by personal recommendation and word of mouth.

Okay - MT

[ In Reply To ..]
Where do I start?

If I cannot find an entry level coding job in a hospital, I would look for a coding job in a doctor's office. I have worked in a doctor's office before. The person doing billing also did coding and collections. I have read on this board from working coders that outpatient coding experience will not help me get an inpatient coding job, that's why I made that assumption.

Why would you think I think that my state has no coding jobs? I was responding to the poster providing a link to a remote coding job. The website listed jobs in various states. I do not think there are no jobs in my state or city. And you say I make assumptions?

Why so harsh? I am just looking for help, starting out as a coder. Okay, I know I came off as arrogant, like I am too good to do outpatient coding. I am sorry for that. I do not feel that way, just asking for advice on whether I should leave MT for a billing clerk job that pays the same or wait for an entry level coding job in a hospital to open up. I do not expect the hospital job to pay more, I'm not looking for experienced coder pay. Why would you assume that? The only job listing I see right now are for billing clerks, not coders. I know there are more jobs out there not advertised. That's why I want to work inhouse so I can network within the hospital and maybe get some personal recommendations. How is that not clear?

More advice from me - Anonymous

[ In Reply To ..]
My advice would be to take the billing clerk job while you continue to look for coding jobs. I was looking for inpatient and outpatient coding jobs while working as an MT and went on several interviews. They all wanted someone with work experience, maybe it won't be the same for you. My time ran out and I got laid off from my MT job. Luckily I was only out of work for a week before going back. It was not a position that was advertised, someone within my organization recommended me. It's not the coding job I had hoped for but I am confident it will lead to other things, particularly since they now understand that MT is not the only thing I am capable of doing. MT is very unstable now, but if you're comfortable playing that waiting game and can afford to be out of work, then I guess you have time on your side. Apparently you've never worked as a coder. You may find that inpatient work is not your cup of tea, so don't limit yourself in that way. Apply for everything. Even jobs on the periphery in HIM or other clinical documentation areas can lead to many opportunities. Someone suggested networking and that is a very good idea. Try to attend AAPC or AHIMA meetings in your area. Sometimes, those people know about opportunities that have not been posted yet. Contact the HIM managers at the facilities in your area, there may be an internship/externship that you can apply for. They may need a per diem person to code or assist in other ways. The entry level coding job may pay the same as the billing clerk job to start, I still don't think you are understanding that. A foot in the door is a foot in the door. Coding is not a static thing but once again I advise you to explore all the possibilities and take advantage of any opportunity that comes your way, because 20 other people probably need that job too. I do not mean to sound harsh, but that is how it is now. Good luck with whatever you choose to do.

I'm with you - I would hold off

[ In Reply To ..]
If you can for a coding opportunity. Billing clerk in a doctor's office is not like coding. I know and understand not wanting to work in a doctor's office. I never want to work in one. I don't like it. If you don't like it and you know it, don't go there. Go down as close to a coding path as as you can get. If the doctor's office needs a coder, and it also includes other stuff, good, but a billing clerk does not sound like a coder. I know, I know, they say take whatever you can get, but you have to also have a stomach for it and it also should have as much to do with coding as possible. I agree it sounds like veering off your trail.

expectations - cj

[ In Reply To ..]
What certification are you seeking and testing for? That credential will hold make a difference in the kind of job you would be more likely to be hired for. In hospital coding, the desired credential is generally CC-S. Without it, you are not likely to get a job coding hospital inpatient. Also, keep in mind that ICD10 has been pushed back to 2014, but most hospitals are gearing up for it now. It is predicted that nationwide we now employ only 40% of the coders that will be needed when ICD 10 is in place as they detail required in coding will be greater and more time consuming. Thus, countless openings will present themselves. Perhaps you might think about starting out in hospital outpatient, ER, or day surgery coding, which is more entry level, and then working your way into inpatient. At our facility, which is very large teaching hospital and trauma center, new hires all start out that way unless they have multiple years of experience as inpatient coders.

That's my plan - OP

[ In Reply To ..]
That's my plan. I want to start out in outpatient coding in a hospital and work my way into inpatient coding. I am going to sit for the CPC first and then CCS by the end of the year. When I first started my coding training, I was anticipating the deadline to be sooner for the ICD10 implementation, and hoping for more job openings, but it got pushed back, so not so many jobs open now. I have decided to just be patient, focus on the certs and then start applying, first at hospitals and then at outpatient surgery centers, and then private practice offices. Hopefully things will pick up after the start of the year, I'm gonna think positively instead of expecting the worst.

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