May 26, 2008

HIM Career Choices: Now in More Colors
By Juliann Schaeffer
For The Record
Vol. 20 No. 11 P. 10

Gone are the days when HIM professionals had but a few black-and-white options. Today, there’s a rainbow of opportunity for those with the proper skill sets and the right dose of ambition.

Although career options for HIM professionals may have been limited 10 years ago, the industry is blossoming and avenues abound for those looking to expand their job skills and climb the corporate ladder.

“Five to 10 years ago, I think we were in the more classic role of health information management: supervising and directing health information management medical record departments. Coding’s been an aspect of the profession essentially at the associate degree level,” explains Claire Dixon-Lee, PhD, RHIA, FAHIMA, vice president for education and accreditation for the AHIMA and executive director of the Commission on Accreditation for Health Informatics and Information Management Education.

Cheryl Bowling, RHIT, CCS, CHC, C-CDI, compliance director for Kforce Healthcare, agrees. “Options were a little bit limited then, pretty much generally confined to medical records departments,” she says. “There were some people working in insurance companies and quality organizations or the old peer-review organizations, [and], of course, in physician offices and clinics. But mostly they were in medical records doing standard medical record operations and procedures—analyzing, clerk positions.” Bowling adds that coding wasn’t emphasized as much in HIM jobs of the past, “but five years to the present, coding has really come to the forefront,” noting transcription as another popular HIM job.

Coding isn’t the only skill that has gained notice. With opportunities varying from clinical documentation and electronic medical record (EMR) implementation to fraud management and pharmaceutical firms, the HIM industry is widening its options, and professionals are beginning to choose their destiny in regard to their career path.

Coding Possibilities
Expounding on the current options for professionals with an HIM background, Bowling says, “A lot of the positions we are seeing emerge are the clinical documentation improvement [CDI] specialists. These positions work with clinicians and physicians to get more accurate, at-the-point-of-service documentation in the record. Many times it’s a role that’s concurrent, on the floor.”

Debi Primeau, MA, RHIA, vice president of professional services at Precyse Solutions, says the CDI specialist is a great career path for coders. “Coders are moving into clinical documentation improvement specialists, and they have a good opportunity these days to expand their skills with their clinical knowledge to be able to help physicians better document,” she says, adding that such skills also allow hospitals to get more accurate reimbursement and correctly reflect severity of illness.

Dixon-Lee says computer-assisted coding is another avenue for those with coding experience. “There, I think the role might be not so much coding the data as input but surveillance of the data quality, the accuracy of the information that might sift through computer-assisted coding, and then working clearly with the clinical staff and improving documentation,” she notes.

Recovery audit contractors and other regulatory agencies may give coders yet another job option, Primeau says. “I think that not only coders but also RHIAs and other professionals have a good opportunity to start to work with some of these other contracting agencies to help them better understand what documentation is required for medical necessity, as well as what documentation is required for accurate documentation in coding,” she says.

For the HIM Director
Many job prospects currently exist for HIM directors who are either looking to advance their careers or try something new. “For HIM directors, there are a ton of opportunities, particularly as they relate to the electronic health record [EHR],” Primeau says. “There are a number of different types of careers as we move forward in implementation analysts, clinical mapping specialists, researchers, and data analysts.”

“You can get into the mapping, the workflow processes of electronic medical record implementation, and even some of the behind-the-scenes development of software that works a little more efficiently and has HIM quirks or highlights involved in the background on the software,” says Bowling. She sees these types of jobs as ideal for HIM professionals who have a knack with computers or a secondary degree in computer language.

“One area that’s really becoming of broader acceptance is a VP [vice president] of revenue cycle,” Primeau adds, “because HIM directors have a good understanding of the entire revenue cycle process from the very beginning to the very end. They’re participating a lot in the revenue cycle process.” For those interested in such a position, Primeau has a word of advice: Learn the language. “They need to learn how to speak CFO [chief financial officer] and understand truly what the revenue cycle is all about and to be very adaptable, to learn that there is not necessarily one right way to do something.”

According to Dixon-Lee, the number of HIM professionals in alternate care facilities is also growing, with EHRs being developed in behavioral health and long-term care facilities. “Those jobs were always there,” she says, “but I think they’re growing in terms of the ability to now really embrace hiring a trained HIM professional and realizing that maybe they need such [help].”

Opportunities are also cropping up in large physician practices for the same reason, Dixon-Lee says. “We see that as both a current and potential future growth area as practices start using electronic health records and need someone either full time or in a consulting role to help them maintain those systems and work with the systems and the clinicians,” she explains.

Fraud Management
Another area where many HIM professionals are getting involved is fraud management. “I think HIM professionals bring an arsenal to help combat fraud in healthcare,” Bowling says. “A lot of HIM professionals are qualified to do this, whether their expertise is in billing or coding or utilization review. They understand the data that’s coming across, and they also have the skill set to review the documentation, analyze, and monitor [it].

“If you look at the data after you’ve coded for a number of years and compare that to other facilities,” she explains, “you can see whether you find a bell curve or whether you see there’s a certain percentage of diagnoses that are above what’s normal for the geographical area in the county, city, or state that you’re working in. Usually this involves recording capabilities and analysis, and HIM professionals have that background and knowledge.”

Dixon-Lee says HIM’s role in fraud management is in “improving documentation and that means doing more outreach to clinicians on a regular basis with documentation improvement programs. Also, [there lies opportunities in] making the case among the clinical medical staff how important [documentation] is and to develop ways to provide training in the healthcare environment. In physician practices, that’s a great role for the HIM professional who might be working with electronic health records to help monitor for physician fraud.”

Guiding HIT Plans
When it comes to forming HIT plans, Dixon-Lee stresses that HIM professionals have a fundamental role and should be part of the initial implementation team. “They know the workflow, and they know the data sources, [knowing] the workflow not just from a specific clinician’s standpoint or nurse’s standpoint by a specific discipline, [but] they know the flow throughout the organization,” she explains. “So they’re really fundamental to the team in terms of preplanning, doing the planning, evaluating systems, implementation and training, and follow-up. I can see them finding roles all the way through, and we have members who are doing that now.

“And some people may work for vendors with systems design,” she adds, noting that HIM professionals may find a home as “part of the implementation team in consulting firms doing these kinds of projects, or they may be in the facilities or the buyers’ location.”

With strong IT backgrounds, HIM professionals can be the unsung stars of any health information exchange (HIE) initiative, according to Primeau. “Because we understand the entire continuum of care and we have a good, strong foundation in information technology, we can actually bring the two together,” she explains. “We’re the intermediaries between the technology and the clinicians, so we can plan for the electronic health records. But it’s not just simply taking that paper medical record and making it part of a computer. We can help with process flows and with privacy and security and confidentiality and access—all of those things that are very innate within an HIM professional’s [skill set].”

Options, Options, and More Options
Dixon-Lee has observed more HIM professionals showing an interest in data analytics jobs, noting that “students are coming out stronger in that category, not just managing the documentation but being able to do more work with trend analysis and data analytics of healthcare information databases.

“Pharmaceutical firms are finding more opportunities for HIM professionals,” she adds. “Here in Chicago, we had quite a few grads going to the corporate office of Walgreens and helping them with data analytics, so that might be a future trend across the country.”

And as HIEs expand nationwide, Dixon-Lee suggests data analytics skills will become even more in demand. “The majority of [HIEs] are probably located in state facilities, [growing] out of state government or public health, but health information exchanges and health databanks—these are all potential possibilities,” she notes. “[These settings] emphasize the health data analytics ability of HIM professionals but also the regulatory environment and knowing codified data, understanding coded data, and understanding the best sources of accurate data really make these people valuable.”

In addition, there are opportunities in the performance improvement and statistical analysis arenas. “HIM professionals have the ability to look at the data, analyze it, and understand what the health information means,” says Bowling. “HIM professionals understand the data and have the ability to slice and dice the data, understand what the numbers look like, and then put it into an [understandable] format.”

According to Bowling, those with an HIM background are also getting more involved “working with insurance and managed care or fee for service. It’s another option for them to take whether it’s looking at data or forecasting for outcomes and working with managed care companies so that they have the ability to understand where their payment flow is going over the next five to 10 years.”

The increased presence of personal health records has given HIM professionals yet another avenue to pursue. “As that starts to emerge (with commercial systems and a variety of types of systems, some through insurance companies), I see health information management professionals as consumer advocates or advisors, helping to guide consumers on their rights,” notes Dixon-Lee. “And there’s going to be some level of ensuring the accuracy of information in personal health records when it might be used by the medical team.”

A Word From the Wise
Hit the books is the advice Dixon-Lee gives HIM professionals who are considering a career move. “I think you can always continue your education, getting that master’s degree or even a doctoral degree,” she says. “I have one and it’s served me well. It didn’t relegate me to research, although it would be great and I think we need HIM professionals on research teams, which is another area for development. But higher education adds a level of credibility and expansiveness to your knowledge, so you’re able to apply it to a lot of other types of settings and circumstances.”

If you’re wondering about how to keep up-to-date in an ever-changing industry, Dixon-Lee says the AHIMA offers any number of outlets for learning, including seminars, practice briefs, training programs, and communities of practice where members can discuss workplace issues.

Primeau tells those looking to take their career in a different direction to “take risks. We’re not typically risk takers. So I would say step out of the HIM department and find out what else is out there. Talk to people and network and volunteer. The health information exchanges are looking for volunteers, [which is] a good opportunity for HIM professionals to move forward in that arena. Sometimes you have to volunteer to be able to get to that next step.”

“I think everybody should have a three- to five-year plan of where they’re going—and then start today,” Dixon-Lee concludes. “Choose a pathway and determine what you can do in the next year, two years, three years out to really stay ahead of the curve and get the job and the salary that you feel you are entitled to.”

— Juliann Schaeffer is an editorial assistant at For The Record.

Self-Branding to Catapult You! in the Job Market
By SAM! Farrell

What images come to mind when you hear the word “tiger”? Does it conjure thoughts of strength, dominance, or a hunter?

These are all words befitting one of the greatest golfers of all time, Tiger Woods, who has accomplished more in his 32 years than most of us will achieve in a lifetime. But would his success and popularity have been the same if he were known as Eldrick, his given name?

Branding can mean the difference between legacy and lackluster. Professional athletes, celebrities, and companies rely on brands to establish a recognizable name and, in turn, success.

Now, individuals are starting to recognize the power of self-branding, or building a strong personal identity based on a clear perception of what sets one person apart from others and the added value one brings to a job or situation.

Branding yourself can yield a number of positive results, not the least of which involves getting an advantage in the job search process. For example, it may mean the difference between getting an interview and getting passed over by candidates who may have “packaged” themselves more successfully.

Effective self-branding for a job search can include the following tactics:

• Develop a list of key attributes. What are your key differentiators in skills and abilities? Unique, compelling qualities can determine which candidate ultimately lands the job.

• Target a niche. The smaller the target audience is for the job search, the larger the brand will appear, making it easier to communicate the right brand message to the right people.

• Be the brand. Everything you do should communicate your branding message. From the resumé and telephone manners to personal appearance and presence during the interview, the individual should accurately and consistently reflect the brand.

• Set goals. Set personal, time-specific brand goals and create a plan of action to stay focused and accomplish desired outcomes.

While at a college sorority event years ago, someone wrote “SAM!” on my name tag to reflect my energetic personality. The brand stuck and I’ve been using it as my first name ever since. After graduating from college, I used SAM! on my resumé, and it opened up opportunities in the interview process to talk about my personality and work ethic.

What’s in a name? Always using a middle initial demonstrates an air of formality, poise, and polish. Choosing an “ie” or “y” ending name such as Bobby (for Robert) or Betty (for Elizabeth) can be a reflection of an approachable, practical, and easygoing personality.

The use of punctuation is another unique addition to self-branding. The exclamation point in my first name expresses who I am. Using one word with this type of punctuation reveals my personality as being direct, enthusiastic, and results oriented.

I use my brand in my e-mail address and on my business cards. These types of details tend to stand out, even on resumés and in interviews. Hiring managers may give candidates with this type of branding another look in the hiring process.

You only have a few seconds to make a first impression. Those who do not brand themselves risk being defined by the resumé reader based on other criteria. So why not plan to stand out, especially when it comes to career advancement? Taking some time to develop a brand can result in being noticed and then recognized as a more attractive and unique candidate.

— SAM! Farrell is the group president of Kforce, Inc.’s HIM division.