Cover Story
BRANCHING OUT
Into an Alternative Career
By Gretchen Berry
On her way to work, Pauline Zellner walks through a tree-lined campus, past students with bright futures and into a building where nearly everyone knows her name.
On her way to work, Madeline Bell walks through fences lined with barbed wire, past people with shady pasts and into a building where she must show ID.
Despite these differences, Zellner and Bell share the same set of skills, apply the same specialized knowledge and work in the same professional field–health information management (HIM).
Zellner is a registered record administrator (RRA) and medical records services manager at The Ohio State University Student Health Center. Bell, also an RRA, is medical records director, statewide, for Correctional Medical Services (CMS), a contract provider of health services for the New Jersey prison system. With the field of HIM continually branching into new areas, Bell and Zellner are among thousands of HIM professionals who no longer head to the medical records department of an acute care facility to practice their trade.
Traditional Practitioners in Non-Traditional Settings
“What interested me about this position was that the job seemed so different,” said Bell. “It was not in the traditional setting, and I looked at it as an opportunity to gain a new and different kind of knowledge.”
Bell’s job consists of travelling to 14 different prisons throughout New Jersey and managing the inmates’ medical records. While the thought of practicing HIM behind guarded walls may seem off-putting to many, Bell insists the experience is not frightening. “Once you get in there and understand the layout and how the system works, you’re really not scared,” she maintained. “You are just reminded to stay on your guard.”
Far from daunted, Bell is enthusiastic about all that her job has to offer. “I have never regretted my decision to work for CMS,” she related. “I could not have gained this type of knowledge anywhere else. Corrections health care is very different. I’ve worked closely with physicians and nurses, much more closely than when I worked in a hospital. This has given me the opportunity to learn a lot about patient care and about what the clinicians need to do their jobs.”
Zellner, too, points to educational opportunities as the reason she loves her job managing the six-member staff at her alma mater. “The Student Health Center is like a family,” she said. “If you are looking to get a well-rounded education, this is the place to do it. It’s a smaller facility, so I have more contact with the patients. I also have more contact with the various service areas, such as patient accounts, insurance services and management information systems.”
She is hoping that this experience, her first job in the HIM field, will serve her throughout her career. “I love working in student health,” she commented. “But I may someday work at a larger facility.”
Like Bell and Zellner, Keri Bowers, RRA, is currently applying her HIM knowledge in a non-traditional setting, although she has not yet made it her career. For the past few years, Bowers, who is director of marketing and health information services for Digital Transcription Systems in Oklahoma City, has been investigating HIM practices in veterinary care and volunteering her services at her veterinarian’s office.
“I have five pets myself,” Bowers disclosed. “I was volunteering my time at our veterinarian’s office and noticed that the system they were using was not adequate. I saw a need for our particular application.” Therefore, she volunteered her special skills.
Although there are opportunities for HIM professionals in veterinary care, they are exceedingly rare. Bowers would like to see that change. “I would make this a career if I could,” said Bowers. “There is definitely a need there.”
Ultimately, Bowers would like to see the development of a centralized, standardized database for pet health records. Toward that end, she has been working in her spare time with computer programmers to design a system that would allow veterinarians and state agencies to exchange and update pet information. “Funding is a problem,” Bowers admitted. “And I think pet owners are more aware of the necessity than are the veterinarians.
“I may not be the best person to do this, but I’m an RRA with an interest in animal care. I definitely see this as a career possibility.”
HIM Goes Hi-Tech
While Bowers continues to work toward a “Master Pet Index,” other HIM professionals are assisting in the creation of a more traditional MPI (master patient index). Sue Trzcinski, RRA, is a project manager for Integrated Clinical Data (ICD) of Concord, CA.
“ICD is partners with Advanced Linkage Technologies of America Inc. (ALTA). ALTA’s powerful probability algorithm identifies duplicate files for the same person with a single MPI or across multiple MPIs,” Trzcinski explained. “Workflow patterns are then assessed and work plans for the cleanup of the MPI are developed.”
Trzcinski’s role as project manager is to assemble clerical support staff and a quality control coordinator to oversee the project. The staff not only analyzes and merges the computerized information; they perform the physical record mergers as well. Facilities usually request this service prior to converting to a computerized patient record (CPR) or installing new software.
“We try to hire HIM professionals, particularly for the quality control coordinator positions,” said Trzcinski. “You need a good understanding of what medical records are and how they function. You need to know the importance of having one unified record and how having two or three records can impact patient care.”
With the growth of the CPR, more vendors and facilities are beginning to understand the value of a collaborative effort between HIM and information systems (IS). Nancy Vogt, ART, CCS, is team leader of client support for the CPR team at Aurora Health Care in Milwaukee, and works closely with the IS department. “We live in both worlds,” said Vogt, referring to herself and the five other HIM professionals in her department.
“As the CPR comes to a site,” she went on to explain, “we conduct training sessions for the physicians, support staff and HIM professionals at that site. We also do database building and testing, as well as process analysis and re-design. The team has to be multidisciplinary and HIM is a big part of that. We understand the paper process, so we understand how to make it better. We understand all the obstacles to documentation. That really helps in actual systems design.”
For Vogt, the move into CPR support seemed natural. “My background really brings a lot to the process,” she asserted. “I have 19 years of HIM experience mainly in coding and database management. I had managed multiple registries and the medical record abstracting database, so I had a lot of systems experience. Working with computers was probably what I enjoyed most during my years in medical records.”
Having successfully made the transition into an alternative career, Vogt is enthusiastic about the benefits her job awards her. “I get to work with people from all different disciplines–nursing, pharmacy, medical technology, physicians, plus technical analysts and database architects.”
Valerie Vold, RRA, echoes these sentiments when discussing her position as a client services representative (CSR) for 3M Health Information Systems. “It’s hard work, but it’s also fun,” she asserted. “I get to travel to different parts of the country and meet people, which I really enjoy. With all of the variety, it’s like having a new job all the time.”
Vold works out of her home with clients across the country helping them prepare to use their new 3M database products. “Once a sale has been made by 3M, the CSR is responsible to oversee the installation of the software at the facility. This may involve working with medical record departments, quality management, utilization management, case management and information systems departments,” she explained. “Then after the system has been designed and installed successfully, we go to the facility to train the client on the maintenance and use of the system.”
According to Vold, this position draws on her eight years of acute care HIM experience while at the same time broadens her HIM skills, especially in the technical area. “We work with the database product which incorporates the CodeFinder software installed either on a single PC or on a network. This database product includes modules for medical record departments, quality management departments, utilization review, case management, and ambulatory care settings, so I have my fingers in a lot of pots. I’m using everything I’ve learned and heading down the computerized pathway.”
That computerized pathway will be leading more HIM professionals to new and exciting career opportunities, according to Vold. “The wave of the future is certainly computers,” she stated. “At some point in the future, this position may not be considered ‘alternative.’ We, as HIM professionals, have successfully served as a bridge between the clinical and administrative areas of heath care. Now we can serve as a bridge between the medical records, quality assurance and utilization review departments and information systems. That is the really exciting part.”
The View from the Other Side
Sometimes the areas being bridged are departments within a facility. Other times it is two different industries that must be brought together. Linda Holtzman, RRA, CCS, helps bring the HIM mindset to the insurance industry as a hospital audit manager for Independence Blue Cross. “Most of the hospitals in the Philadelphia region are used to getting calls from me several times a week,” she professed.
“I develop reimbursement methodologies that are based on codes,” Holtzman continued. “For outpatient fee schedules, for example, I am part of a team responsible for determining which procedures are payable and at what level to pay them. I also set up different system edits to screen the codes on the claims as they come in. By the time they get to the reimbursement segment in the claims system they are ready to pay.”
In addition, “I or my crew selectively audit those claims to be sure that they have actually done the CPT code reported. We also do DRG audits. We do charge audits. We do cosmetic audits. Basically, however the claim is going to be paid is how we are going to audit it.”
Holtzman’s staff consists of two other RRAs, and three registered nurses (one of whom is also an accredited record technician [ART]) and also a claims analyst. Their knowledge of clinical procedures and terminology, as well as their familiarity with coding, are integral to Blue Cross’ reimbursement practices. And, according to Holtzman, there is an exchange of professional knowledge between the coders and the nurse clinicians.
“What I like about this job,” she declared, “is that it gives you a more complete perspective. I see the record from the time the physician fills out the documentation, to the time it gets coded, to when it goes to billing, to when it gets submitted, to when it gets paid. I can see the progression from start to end and have a very clear picture of how the coding, billing and reimbursement angles all fit together.”
Like Holtzman, Hope Rosen, RRA, has come to understand the importance of good documentation. Rosen is a disability claims examiner for the state of Kansas. It is her responsibility to gather and review medical information to determine if applicants are eligible for disability benefits.
Prior to accepting this position, Rosen worked for two decades in acute care HIM departments. “My HIM experience relates in that I know how to review records,” Rosen explained. ” I also have insight on how to obtain records, how the HIM department works and what the rules are. It has also given me a knowledge of medical terminology, a knowledge of disease processes and a basis for making these determinations.”
It is a process and position that Rosen finds truly fulfilling. “I get a feeling of satisfaction whenever I can grant a deserving claimant the assistance they need,” she attested. “I also like knowing that I am saving the taxpayers money when I can make an expeditious decision on any claim.”
The time Rosen has spent obtaining and reviewing medical records has reinforced for her the importance of good HIM practices. Marie Gardenier, MBA, RRA, has made a career out of providing them. As head of Gardenier & Associates, she provides a wide range of HIM services on a contract basis in areas such as project management, data quality and process redesign.
Her position allows her to apply her years of acute care and consulting experience to all areas of HIM. It also gives her the opportunity to concentrate on the areas that interest her most. “My work has evolved as the practice of HIM has changed over the years,” she explained. “Right now a lot of the work I am personally doing involves planning for and implementing information technology inside HIM departments because that is where my personal interests and client needs converge.”
Although Gardenier’s job provides her with more variety and a broader perspective than most conventional HIM roles, she bristles at being labeled “non-traditional” or “alternative.” She is active in the American Health Information Management Association (AHIMA) and, like the rest of the professionals interviewed for this article, maintains firm ties to the HIM community. Being an HIM professional, she insists, is about more than where you report to work. “It’s about the professional principles we share, our knowledge base, the values we possess as HIM professionals and how those tie us together.”
That knowledge, those principles and those values are in demand in areas that many HIM professionals have never considered. On the other hand, many of these areas have never considered HIM professionals as a way to meet those demands. “The posting for the position I now hold did not ask for someone with medical records experience,” recalled Vogt of Aurora Health Care. “I applied anyway and because of my resume, they granted me the interview. In some organizations they don’t realize the skills that HIM professionals have. If you don’t apply for those jobs because you don’t think you’re qualified, you’re going to miss out. Often, employers are willing to train you if you can demonstrate that you have the skill set and the enthusiasm.”
With so many options, both obvious and obscure, open to HIM professionals, branching out into a new career is simple. The key, according to Gardenier, is simply opening your mind to the possibilities. “You have to examine your skill set, your knowledge base and your values–your core as an HIM professional,” she advised. “Then determine how you, as an individual, can apply them. Resist the urge to categorize yourself and erase any boxes you’ve drawn in your mind.”
Gretchen Berry is an editorial assistant at ADVANCE.
