July-August 2020

The Pandemic’s Effect on the Coding Job Market
By Scott E. Rupp
For The Record
Vol. 32 No. 4 P. 18

Take the long view and—despite recent job losses—coding remains a strong career path.

So far, the first year of the second decade of the 21st century has brought a lot of uncertainty—to say the least. Through April, more than 30 million people had filed for unemployment as the economy contracted by almost 5% in large part due to COVID-19.

Before the pandemic, the economy was among the strongest on record, with unemployment at or near the lowest reported levels in decades. However, COVID-19 had shut down nearly 30% of the economy, including large swaths throughout health care.

Medical billing and coding had been among the most in-demand professions. In fact, the Bureau of Labor Statistics listed medical coding among the 20 fastest-growing occupations.

AAPC notes that “job security factors into quality of life, which is one reason why medical coding is a good career choice. Despite economic fluctuations impacting employment opportunities for most professions, the need for health care professionals, including health information technicians, is at a historic high—and will remain so.”

What About Immunity?
Health care has traditionally been thought of as a sector immune from the ups and downs of the economy. According to theory, people, no matter what, always need care. However, no one conceived a reality in which an increasingly global citizenry coupled with the emergence of a devastating virus introduced to a vulnerable population would bring about a shuttered national economy.

To curb the spread of the virus and save lives, nearly all elective procedures were limited. Patient visits cratered throughout the entire health system. Facilities laid off or furloughed thousands of “nonessential” employees who joined the multimillions from service sectors and other related professions suddenly on the street. Even as “reopenings” emerge across the nation, many are hesitant to seek care, fearing it’s not worth the risk of contracting COVID-19.

Coders were among the hardest hit by the economic shutdown. The reduction from an annual patient visit volume surpassing more than 1.4 billion to one far less meant a dramatic reduction in the need for coding professionals. The profession experienced dramatic suppression, with the likelihood of a quick restoration of jobs in doubt.

Bill Wagner, CHPS, CPCO, chief operating officer and cofounder of KIWI-TEK, a provider of outsourced coding services, won’t be surprised if it takes a while for the job market to return to its previous level. “I think there’s going to be a very slow recovery back,” he says. “By July, [I think we’re] not going to be anywhere near back to where it was. We might recover back to 40% to 50% fewer patient visits, so there’ll be less need for coders.”

Wagner estimates that the volume of patients may return to normal by October, but by then many coders may be forced to find new options for work. Those who remain must adapt to the new health care landscape, grow their skill set, and find ways to best serve employers, he says.

A New Landscape
More than 72% of coders work for a hospital or a health system, according to the HIM Professional Census 2020 conducted by Libman Education. Of those, more than 50% were fully remote-based employees; only 17% of coders reported that they were based entirely on-site.

In addition to creating nationwide unemployment not seen since the 2008 recession, the pandemic required new ways of working for those still on the job. The Medical Group Management Association found that telemedicine has increased dramatically during the initial COVID-19 pandemic, primarily because of the need to minimize the risk of exposure to the virus. Virtual visits in the United States are expected to exceed 1 billion in 2020, a recent Forrester report points out, with COVID-19–related care accounting for 900 million virtual visits.

Many HIM leaders are unsure how to document these patient interactions, which will create a high demand for coders who can do so.

As telemedicine visits skyrocket and as the demand for remote-based coders continues, hospitals and health systems that embrace remote-based coding will soon have their pick of the litter, Wagner says. HIM leaders will realize they can “get nines and tens” by hiring remote-based coders from outside their immediate geographic area, “not just the fives and sixes from [their own] area,” he says.

Those with experience coding telemedicine services and those who can work anywhere will set themselves apart from the suddenly very competitive landscape, Wagner notes.

Competition Abounds
The rise in remote-based coders may see a push from offshore coding companies, which will add even more competition to the increasingly growing talent pool. With hospital finances taking a massive hit, many HIM leaders will use the circumstances as an opportunity to engage in conversations with coding companies outside the United States.

Wagner argues that such a path is pennywise and pound foolish, however. He admits, though, that even the HIM leaders not in favor of offshoring may cave to the attractiveness of such offerings when pressed. “I can see an opportunity for offshore companies trying to grab more business, which means fewer jobs for more coders,” Wagner says.

In a tightened job market, the best US coders must set themselves apart from both offshore firms and their colleagues stateside. The quickest route for doing so may be through education.

According to the AAPC, individuals who’ve learned the health information profession through on-the-job training and work experience may want to begin earning certifications in one or more specialty areas. Doing so can improve their earning potential and set them apart from other professionals both on and offshore.

Education also helps mitigate many of the most pressing professional fears of those working in the field. Among the individuals surveyed as part of “HIM Professional Census 2020,” the three primary concerns for impeding careers were the following:

• keeping up to date on annual changes to coding systems;
• preparing for significant revisions to the coding systems; and
• staying current with advances in technology that affect the job.

Consider Specialization
It may be a good idea for coders working in a specialized physician’s office or practice to consider adding specialty certification to their credentials.

The median annual salary for medical coders with a specialty credential is $62,175, which is 8.7% higher than the median salary of $57,201 for nonspecialized CPCs. Specialty certifications from the AAPC are available for multiple specialties, including ambulatory surgical center, anesthesia and pain management, cardiology, dermatology, emergency department, pediatrics, and urology.

Specialization can help professionals gain an edge on the competition while letting potential employers know they take career development seriously and are committed to growing in their craft. For example, risk adjustment coding can play a vital role in securing reimbursement for most practices and health systems.

Standing Out Among the Crowd
Rae Jimenez, CPC, CIC, CPB, CPMA, CPPM, CPC-I, CCS, senior vice president of products at AAPC, says employers seek coders who are certified, stay on top of their professional development, and commit to lifelong learning. “Those who stay current and are dedicated to the profession and are taking it seriously” are strong candidates for long-term success, she says.

While every employer has its standards, contributing to a provider’s bottom line is key to long-term success in the role. No employer will keep a coder that is not positively impacting the organization’s revenue cycle, Jimenez says, adding that there are several attributes that can increase an individual’s chances of success.

A detail-oriented curiosity for the task at hand, the ability to research and extrapolate the finer points of a problem, problem-solving capabilities, and being a critical thinker capable of working on their own form the foundation of a strong coding skill set, she says.

Likewise, as many coders move into remote-based roles, they must thrive in an environment where they have little direct supervision, yet are assertive but respectful with how to approach caregivers and are confident in their abilities and knowledge to gain the trust of others while maintaining a high level of professionalism.

Speed and accuracy also are essential, Jimenez says.

How and Where to Find Work
While coding jobs may become harder to find in the short term, the long-term outlook is brighter. The Occupational Outlook Handbook published by the Department of Labor estimates the following:

• Employment of health information technicians is projected to grow 18.2% between now and 2028, a rate that is faster than the average for all occupations.

• Additional records, coupled with the widespread use of EHRs, by all types of health care providers, will lead to an increased need for technicians to organize and manage the associated information in all areas of the health care industry.

Also take into account an aging population—baby boomers make up 20% of the population—and estimates from the Census Bureau stating that the number of people age 65 and older will increase 55% by 2030, and the likelihood of long-term job growth in the profession is strong.

Nevertheless, capturing these opportunities requires diligence, research, an expanded knowledge base, and broader networking.

Jimenez recommends aspiring coders take the following actions:

• Grow your professional network: The bigger, the better. This includes using social media to connect with other professionals, as well as joining professional organizations. Professional associations provide members access to job boards and organizations seeking qualified employees.

• Find a mentor: If you need career advice or have questions about how to identify new opportunities, mentors can help navigate the process and provide referrals and leads.

• Take a transitional job: Newcomers may need to accept a transitional job or a coding-related position to get a foot in the door. Eventually, they can use this as leverage for opportunities more in line with their goals and passions.

• Switch specialties: Mid- to late-career coders may have to switch specialties to create new opportunities or to secure career advancement. For example, they may need to move into auditing or management roles.

• Engage a professional recruiter: Recruiters are more likely an option for coders with advanced experience or those with specialty qualifications, but they can help open new opportunities for others as well.

Valerie Brock, HIM program director at Tennessee State University, says job seekers may have a better opportunity of landing a position if they enlist the help of a recruiter, adding that those who apply through job boards such as LinkedIn and Indeed.com have a greater chance of being noticed by recruiters.

“Usually there is a small fee involved after the candidate gains employment,” Brock says. “Recruiters develop a relationship with the job seeker as information is gathered about work experience, desired coding specialty, salary, and more. Recruiters are the key to getting your foot in the door to an ideal company.”

These arrangements may work for some, but candidates must ensure their résumés are not shotgunned to every health system in the area, Wagner says. In his experience, recruiters have not always helped identify new talent.

“There’s a lot of talk about recruiters and how disappointed professionals are working with them,” he says. “They just threw dozens and dozens [of résumés] at us and none of them passed minimum certifications. Recruiters would be the last place I’d go.”

Instead, Wagner suggests candidates explore the websites of health systems and hospitals. “That’s the first place I’d go,” he says. “Medical coding companies is the second place I’d go.”

Other options include Jobs for American Medical Coders on Facebook, which has a large community where people discuss jobs, request help, and share their personal stories, and the jobs page on the AHIMA website.

Candidates can further separate themselves from the pack by paying attention to details. For example, Wagner encourages candidates to introduce themselves in an e-mail message. Don’t just send the résumé as an attached document without some sort of introductory note, he says, adding that the subject line should include information about the message’s contents.

Brock says candidates should make it a priority to practice their interview skills. “This will reduce anxiety and help you to sharpen your skills and make you feel more comfortable for the interview,” she says.

Jimenez encourages individuals to “exhaust all opportunities to find a job” and remain diligent, “using all avenues available to you.”

“Job searching is a project that takes time and patience and there’s lots of competition in the job market,” Brock notes. “You are competing with other candidates with similar skills for the same job. Sometimes you might feel like you have come to a dead-end road.”

Short-Term Pain, Long-Term Gain
Despite the chaos inflicted by COVID-19, coding is a strong profession to pursue, Jimenez says.

“Despite the economy, there will always be a need for medical coders,” Brock says. “It is predicted that more medical coders will be needed in telehealth, behavioral health, and other technical communication health services.”

Dedicated and passionate coders can enjoy long careers. The profession is an attractive option—even in the midst of a pandemic—for those who want to work in health care but have no desire to be involved.

— Scott E. Rupp is a freelance writer based in Florida.