Jobs for HCC, New Coders, and Auditors – I have to tell you, this is going to be a fun slide for me, so I’ll try to contain myself.
Q: “What kinds of places hire HCC coders? Well, you’d be surprised. As a new coder, I was wondering how you get experience to be able to get your foot in the door when looking for a job. Can you tell me what an auditor should be proficient in to be successful?”
A: Well, let’s go look and see what I came up with. Actually, you might be surprised to know that there’re multiple places that HCC coders can work. There are more than one phase to HCC coding, but generally you could get hired at a physician practice, maybe not an individual physician, a sole proprietor-type thing although it would behoove him to or her to have an HCC coder there, but a larger practice, and you might be one HCC coder for several docs. Again, physician practices need to have education with HCC coding if they take Medicare patients.
Ultimately, I could just sum this up and say, “Anybody that takes Medicare patients needs an HCC coder, but there're other places that you could work.” There are MA plans like UnitedHealthcare for example is one. The MA Plan is the one that all the information is being tracked for. You could actually work for the MA Plan or you could be from a contract company like Optum or Aviacodewhere the MA Plan, UnitedHealthcare, contracts out Optum to take care of all their HCC coding. Mind you, HCC coding is not just one thing. Sometimes, you're getting the HCC codes and the RxHCC, and you're doing three pulls a year.
I was just talking to an HCC coder, another one who happened to work for Optum, and it’s been a while now since I worked for them and I said, “Has it changed? Are you coding for one thing one day and another thing for another day? Or do they have you just doing one?” And she goes, “Oh, it changes every day and sometimes more than once in a day.” Again, it’s more than just pulling HCCs out of encounters. It’s a very diverse program. Like Optum, I asked her, “Are they still doing fantastic education?” “Absolutely.”
If you work for a contract company, they are probably continuingly giving you education on what they need to make you better, because they’ve invested in you. When you start these types of contracts, these people don’t usually leave. They stay for a long time.
Medical Coding Jobs for New HCC Coders and Auditors – Video
The other place that is really growing in hiring HCC coders is hospitals themselves. I know at our local chapter for St. Louis that there's a group of HCC coders there, and they work for a hospital, and I think, if I remember right, there were five of the coders there and they're looking for more. This is for like the SSM System. They don’t just do the one hospital, they're doing several hospitals, maybe, in the area and they have five to eight coders that they just deal with HCC.
Again, there's more to it on a hospital level as far as coding for HCC, because they're prepping for RADV audits and the audits from the MA Plan and everything. So, they're doing a different end of work than, maybe, the contract companies are doing for the MA plans. So, they're looking everything different.
The hospitals are getting all of their records ready to go and optimizing them so that when the contract companies like Optum for the MA Plan, they come in and ask for the documentation and it’s ready to go and then there're no problems, they can just abstract that information and nothing gets kicked back.
Again, just like everything else with coders, there's a timeline there and it can be very sensitive. You want to get those. You have three pulls in a year for the information, and those hospitals want to be on top of it. So, they are actually getting very proactive now and you'll start seeing more and more HCC or Risk Adjustment Departments in with the Coding Departments, which is very exciting to hear. I like that very much.
So, what is going on? Well, if you really want to be an HCC coder, the first thing is you have to be certified. They don’t care if you're a CCS or a CPC, they just are going to require you to be certified. You have to be comfortable with ICD. You are only pulling diagnosis codes, no CPT codes.
You also want to be very comfortable in taking an ICD test. So, they’ll give you a pre-employment exam and ask you to pull out all of the diagnoses, not HCC diagnoses, they're going to want to know can you pull out all diagnoses. They’ll worry about the HCC later. Usually, that’s the type of pre-employment exam that you would go and then take.
The other thing that I wanted to mention that isn’t on a lot of peoples’ radars is the fact that you probably want to be really good with Excel. When I did my pre-employment testing for Optum, for example, I had an ICD test which was not bad – at least I didn’t think it was bad, pulling out those diagnoses codes and getting the proper diagnosis to the highest specificity, mind you not just pulling out the diagnosis codes – but they also had me take an Excel test which I was kind of surprised. I work with Excel, but they gave me a little training course that I was able to access and then I needed to take the Excel test.
After I started working for them, I realized why it was very important to do that, because unlike coding for a facility where you just put in your codes and send – I did that for some time – but then they switch up the way they're doing things. Sometimes when you're coding for another project that they have going on, they want all the information put in an Excel sheet and they have all of these windows and stuffs set up. So, you have to be comfortable navigating an Excel program to be able to do that because they don’t want to spend time training you how to use the spreadsheet. They want to focus their training on how to get the best HCCs and capture those.
Again, I would take the time, if you're not, maybe Excel certified or you're not comfortable with that, that you take the time to do that. There're so many places you can do that. You can Google it and get education and training on Excel very easily, but I think that’s a good thing to have and put it in your résumé.
Another thing that is very important for HCC coders, you have to be comfortable with online research. Every day that I was doing the HCC coding, I was researching something and this could be one of these three: medications, treatments, or the disease process. Again, remember, you are pulling out just diagnosis codes, but you have to get to the highest specificity for that code and you also have to prove that the diagnosis is being actively treated. That is something that is not always easy to do at first glance.
You may have a patient that it stated that they’re diabetic, but just because it says they have a diagnosis of diabetes, but if it’s not mentioned anywhere else in the documentation, it doesn’t say what type of medication they're on, that they're getting their feet regularly or they're getting their eyes checked for diabetic retinopathy, then if you can't draw a line to prove that they actively are obtaining treatment for diabetes, even though you know they’ve got it, then you can't count that on that encounter.
Now, you say, “That would never happen,” but it does. In HCC coding, what you're doing is you're taking each individual encounter. It has to stand on its own even though you get a year’s worth of this patient’s documentation and from day one that you start looking in that date, you may know, “This person is a diabetic. This person is a diabetic. This person is a diabetic,” but that encounter doesn’t have that information. It happens because the doctor knows it but doesn’t document or it’s not pertinent to the care of the patient on this particular encounter. Maybe they’re there because they have a respiratory infection.
So, he mentions that they’re diabetic but it doesn’t mention that they take the medication.Or, let’s do it the other way, let’s say you’ve got their medication list and you know that they take insulin but nowhere does it mention that they’re diabetic. You can’t code them if for HCC is being diabetic just because they take insulin. It has to be stated, there has to be a diagnosis with a line that you can drawthe actual treatment.
Again, let’s say, “Well, what’s the big deal?” You’ve got all that documentation for a year. Well, what if this is an incredibly healthy diabetic and they’ve only seen a doctor four times in a year?Now, again, is it going to happen? Yes! It does! And if you cannot find a clear, what we used to abbreviate and say a “clean document” or we’d say a “dirty document” meaning the physician doesn’t have his credential on this encounter so it’s thrown out. The physician’s signature isn’t a valid signature – that one is thrown out. I can’t see the date of service clearly, it’s smudged – that one is thrown out.
Each encounter has to stand alone, it has to be a clean encounter. It has to have everything, has to be copacetic in that encounter. If that’s the only one you’ve got and it doesn’t mention diabetes, you can’t capture diabetes for that year. And that’s going from a contract company type thing. That’s why you’ve got these hospitals and these physicians that are getting HCC coders to make sure that they’ve got all of these HCCs or chronic conditions captured cleanly in their documentation.
Again, medications, you need to be real savvy with medications. Don’t think that you have to have it memorized because you can go out to, like, drugs.com and get that or webmd.com, treatments that are involved. If you don’t know what the treatment for atherosclerotic heart disease is, then how are you going to draw that line for that diagnosis?
Also, just the disease process itself, knowing that this particular disease, this diagnosis can turn into this one. You have these ballooning effects with certain diagnoses. You need to know that certain diseases are associated, like, hypertension and chronic kidney disease. If you don’t know that that disease process has that link, then you may not be able to code to the highest specificity and catch those HCCs. So that’s what basically an HCC coder does.
What are the recruiters looking for? Well, because I have a background in HCC, I do get lots of recruiters sending me information and they also were asking if you know someone – because as you know, coders know each other and we’re connected and stuff. Here’s one that comes up, like, every year that the HCC coders kind of giggle about because you think, “Oh, this would be really fun.”
This is a recruiter that recently sent this one out, says, “I found your background an impressive fit for a career opportunity with Episource, a leading healthcare service provider focused on Medicare, Risk Adjustment (thus HCC)coding and analytics. We are looking for a Certified coder (CPC, CPC-H, RHIT, CCS, or CCS-P)…” They list the certifications that they’re looking for. Now, mind you, maybe you are not one of these, but these are the basics. If they list and you don’t have that certification, feel free to reply. That’s what they’re saying they’re looking for. That doesn’t mean that you might not be a perfect fit for that with a different coding certification, maybe you have a specialty.
“This is a one-year contract…” that happens a lot “…that involves travel to different parts of the island of Puerto Rico, all travel expenses will be covered. Let me know if you are open to a conversation.” This one goes around and honestly this one doesn’t say you need to be bilingual; but it usually states thatyou need to be bilingual on this one. So, there’re some great HCC coding physicians inPuerto Rico obviously.
Then we had this one, says, “Hello. I am still looking for more HCC Coders. Do you know any that are bilingual and interested in travel to Puerto Rico?” I put that one on there because this is a different recruiter for that same job, I’m sure. Again, do you know somebody? That’s what they’re saying.
Here’s another one, “I’m reaching out about the Director of Coding & Quality Training search I’m conducting for Verisk Health. The position is based in Richmond, VA but extensive travel to Richmond is also acceptable.” Meaning, that you can work remote. Now, that’s something you want to pay attention to because HCC coders often work remote.
Again, when you have your resume out there, you want to let them know you’re open to working remote and that you’re comfortable working remote and you’re set up to work remote. Just because you want to be a coder and work from home so you can stay home with your children, it’s not an acceptable answer. Don’t even give that answer because it’s not conducive to being a good coder. If you say that to a future employer, they’re going to back up real fast because in the real world, staying home with your children and working in coding is not easy to do.
“Some information on the position is below.Do you know anyone who might be interested? If so…” In other words, these recruiters are linked. Now, the other thing I wanted to let you know, these particular ones that came in, they came in from LinkedIn, so I would tell you to definitely get on LinkedIn if you’re looking to be an HCC coder or you are anHCC coder.
The thing about LinkedIn though is you have to be incredibly professional. Now, that means if you’re on LinkedIn and you’re on Facebook, they can tap in to you from both. So, if you keep your LinkedIn very professional, which you should, then you want to not wear big crazy jewelry. You don’t want to have one of those sexy poses on there. You want to look professional.
You need to do the same for your Facebook page because they’ll find you and they do look for you. They’re taking a chance on you especially if you’re working remote and the only thing they know about you is what they can find online, so if there’s anything inappropriate online about you, they will find it and your resume will get tossed.
So, keep your LinkedIn professional,keep your Facebook professional. Don’t tell them about going out on the weekend and all the fun that you had and definitely don’t have pictures of that. You probably want to keep your Facebook in private mode, but don’t have your LinkedIn or yourFacebook picture one – if you’re a woman with various parts of your body exposed more than necessary, things like that. Keep your clothing professional, keep your smile professional, and any comments that you put on there – that’s professional.
Have a good resume, make it short and sweet. They don’t need to know everything that you did in your life, you want it one page. They want to know: Are you ambitious? Are you willing to do research? And, what your personality type is: are you focused and driven? What I meant by personality: can you handle change? Because like I talked with the other HCC coder this week, again, it changes constantly. You won’t be doing one, same thing every day. You have the possibility of doing multiple things. Very important, so those are the tips that I would give you.
Now, for auditing, I know you asked about that, the same things apply for auditors, but with an auditor, attention to detail – I know you’ve heard that before – is very important. Willing to constantly learn and network, very important. All of the same things apply for HCC coding as an auditor but being able to handle change with an auditor as well as in auditing, you’re doing a lot of education. So, make sure that you feel comfortable that you can stand behind what you’re telling the physician or whoever you’re auditing. There’s a huge educational aspect and you need to be able to back it up. OK?
I think that if I haven’t got you excited about doing HCC coding yet, that watching this will help you feel more comfortable.
Tammy: Hey! Can I say two things about your HCC and questions?
Laureen: Yes, please.
Tammy: Number one, there was a little blip on there that said something about what do auditors need to know? You need to know it all. What I mean by that is you need to be familiar with your ICD-9, your CPT and your HCPCS; so you need to be good with that.
On the other hand, I am a remote coder and it doesn’t make any difference what company I go to, but one of the first questions I’m always asked is: am I an HCC coder? And I could tell you the reason why, but it would be talking about another company and I’m not going to promote any company. But I just want to throw that in there.