We interviewed Corrie Alvaraz, who has been in the medical coding field for 30 years, to learn more about this career.
Q: What is your current job title?
Educator/Auditor/Revenue Operations Manager.
Q: Tell us about your job and the most challenging aspects of the work?
I perform random chart audits; conduct workshops on coding; train new coders; participate in process improvements: evaluate a process to determine if it can be improved upon. We would look at the time a task took to complete, the steps needed to complete each task and to make sure each task value-adds to the process.
In improving processes, the goal is to save time, money and resources.
A coder takes a source document (which can be written, typed, paper or electronic) and converts the written documentation (x-ray, operative report, pathology report, office visit, etc) into a series of codes. For example, a patient may come into a clinic with a chief complaint of cough The cough is converted to 786.2 (diagnosis code). The physician may then decide to order a 2 view chest x-ray in order to rule out pneumonia. The chest x-ray is converted to 71020 (procedure code). There are also codes and rules on how to code office visits based on the documentation in the chart. These codes are submitted to an insurance carrier (usually electronically) so that they know exactly what was performed (procedure) for a patient and why (diagnosis). This allows a physician to be paid accurately.
Coding can be difficult because in a written chart, the physician’s handwriting may be a bit challenging to read or the type of service (or the case/situation) may be complicated. For example, many coders find coding for a cardiovascular surgeon challenging.
It’s difficult to be an “expert” in every type of coding. However, that doesn’t mean that someone who has been an OB/GYN coder couldn’t work in Orthopedics, it would just take some research and finding someone that could help mentor you through the difficult cases. Many of the surgical aspects of coding will be similar, the anatomy, obviously would not be.
Another challenge, is with the payers. Not all payers have the same coding rules. So, a coder not only has to know the general coding guidelines, they need to know when the payer has specific coding rules that differ from the general guidelines. Not knowing/applying these specific rules when necessary, may cause payment denials, delays or less reimbursement for the physician.
So, some coders choose to become specialized in a certain disciplines. For example, I have a specialty credential in emergency room coding ( CEDC). To be specialized, you need to take another exam that is specific to that discipline (cardiovascular, orthopedics, OB/GYN, Dermatology, ENT, etc).
Q:How long have you been in this current career?
I’ve been in the Medical billing and Coding field for 30 years.
Q:Where do you work?
I work for a national company. Without corporate approval, I cannot give the name. However, I can tell you I conduct workshops and seminars for the AAPC.
Q:What other types of work places could you work?
Other employment opportunities would include medical groups and insurance carriers.
Q:What is a typical day like for you?
Prepared material for training, researched complex coding questions and attended a conference call on documentation improvement strategies.
Q:Is this typical of most days?
Every day is a new adventure in that you never know what change has taken place; e.g. insurance carriers may change their regulations; problems may surface that need immediate attention, or someone will need assistance with an insurance claim.
Q:What parts of your job do you really enjoy?
Mentoring new coders, educating providers and knowing that you were responsible for improving a process that saved time, money and resources.
Q:What parts of your job do you really dislike?
As a manager, there are department goals and standards that need to be met. It can be a bit stressful, especially with a group of employees. I try to get everyone to understand the big picture and to embrace team work and to not create silos.
Q:What qualities would someone need to have to do your job well?
Embracing change, enjoy networking and be willing to continue to improve what you know.
Q:What is a typical entry-level salary for your field?
$18-$35 per hour, more for management positions and consultants. A consultant would make anywhere between $100-$250. an hour. If a coder works from home, they make less than an in-house coder. A traveling coder would be paid on the higher end of the scale. Also, some specialties are more difficult, like interventional radiology or cardiovascular surgery. These coders tend to be on the higher end of the scale as well.
Q:What is the most you can typically earn within your field?
An experienced coder can earn $40 per hour, while a manager/director employed in a large medical large group may earn up to $100k, with a consultant earning up to $200k.
Q:What is the typical next career step for people in your field?
It’s a wide-open field. Many coders seek to start a home-based business-in medical billing, become a consultant, or work as an auditor of medical claims.
Q:Will this be your next step or will you do something different? Why?
I am in the final third of my career and seek to work less hours. My colleagues laugh at me but at least it’s a goal.
Q:Were there any special licenses or certifications that you need to receive before getting a job?
In California the core credential is the CPC (Certified Professional Coder). After that you can sit for specialty exams. I took the AAPC exam for a simple reason: this association has a community based networking system for coders with state chapters created by coders. Most chapters meet monthly to hear lectures on coding and to network. This is a very important component to the career.
Q:What type of education or training did you receive to enter into this career?
I have a BA. I wanted to be an elementary teacher. I was working my way through college by working in the medical field. By the time I was ready to graduate, I was making more money in the medical field than a first year teacher. So, I stayed in medical field.
Q:What school did you attend and where was it located?
Cal State Northridge.
I took a class in Medical Terminology and Anatomy at a local community college. I then attended workshops to fine tune my coding skills. This included reading and studying for the CPC exam. I completed this training in about one year.
Q:How long ago did you attend this school?
Since I was a part-time student (evenings) it took me almost 10 years (proves I have endurance and patience).
Q:How would things be different for you if you hadn’t received this training?
Training provided the opportunity for me to constantly learn and meet new people. And since I had been working with nurses and physicians since I was young (age 13), I was comfortable with the content of all classes.
Q:Do you think you progressed farther in your career because you received specific training?
I think I progressed because I never stopped wanting to learn and network and the training I received helped in both regards. In addition, being engaged with the local chapter helped not only my career, but, boosted my confidence and opened a lot of doors.
Q:Were you satisfied with the training that you received?
Yes, the classes in medical terminology and anatomy and the workshops in coding were both great experiences and help me prepare to sit for the AAPC exam. It was a great experience.
Q:What were your favorite classes and why were they your favorite?
Since I only took Medical Terminology and Anatomy, they both were good classes and both were instrumental in helping me prepare and pass the certification exam.
Q:What specific skills did you take from the program that you use in your everyday job tasks?
I had been working in the medical field since I was 14. I loved learning and I was lucky that I had some great mentors that allowed me to observe everything and ask a lot of questions. In this field, it is important to have a mentor. A person who helps you develop a passion for your work and to give you a reason to show up to work every day, even when you don’t feel like it. I was fortunate to have two. One was my mother, who at 82 is still a full-time coder. The other was a physician, who taught me that work could be a salvation from a bad relationship, family problems, or other challenging life issues. He taught me to work hard, do my best, maintain a good work ethic and give back to others.
Q:What was the most important class/lesson from the program?
That there are many gray areas and it takes sound judgment, combined with experience, to properly code some cases.
Q:Was there a certain book that you still reference for your job that you could recommend to others?
Ingenix’s Coder’s Desk Reference. It helps me through some really tough cases!
Q:If you could do it all over again, would you?
Q:What was the most difficult part of the program for you?
Staying focused and on track.
Q:About how many other students were in your classes?
They were large classes with about 40 students in both the anatomy and medical terminology classes.
Q:Were any of your classes online?
I’ve never enjoyed on-line classes. I love the interaction of a classroom.
Q:Did you consider other schools or programs?
Q:Why did you choose the one you did?
Classes were held at a local community college near my home.
Q:Would you recommend this school to someone else?
Yes. They have great classes, taught by experts and at a great cost. Some of the private schools out there are not worth the expense. I’ve heard of some billing/coding courses that cost $12-15k. I always advise students to stay away from them.
Q:For your career, is there ongoing education that is required?
Yes, we are required to obtain 18 CEUs (18 hours) of continuing education hours per year.
Q:For your career, are there any organizations that are beneficial to join?
I am a proud member of the AAPC. I joined their organization because of the local community chapter networking opportunities. If you take their exam, you are a member and you keep your certification by staying current with your CEU’s ,which are 18 credits per year-which equals 18 hours (one hour per CEU). Our local chapters host monthly meetings where members can obtain a low cost education to fulfill the continuing education requirement.
Q:If so, what are they called and what do they provide?
“Members” can host events and facilitate workshops.
Q:How much do they cost to join and renew each year? Student member is $75.00 per year.
Regular membership is $125.00 per year.