How to Create a Career in Medical Coding

Career paths are rarely linear – they're filled with twists, turns, and a little luck. That’s why we’re excited to have Sandy Giangreco Brown, the Director of Coding and Revenue Integrity at CliftonLarsonAllen LLP, on our podcast to discuss her career trajectory with our host, CJ Wolf, MD.

Sandy's resume includes job titles like Certified Nursing Assistant, EMT firefighter, Coding Education Supervisor, and more. She shares her unique career path and the creative (and cost-effective) ways she finds time to continue advancing her education.

Tune in to our latest episode of Compliance Conversations, “Unexpected Ways to Advance Your Medical Coding Career,” as we discuss:

  • The one phrase that helps build collaboration and understanding between providers and compliance or audit professionals
  • Creative ways to make professional development and education work for your schedule
  • How to get your foot in the door for career opportunities

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Unexpected Ways to Advance Your Medical Coding Career - Podcast

Episode Transcript

CJ Wolf: Welcome everybody to another episode of Compliance Conversations. I'm CJ Wolf with Healthicity, our sponsor and host, and we have a guest today, Sandy Giangreco Brown. Welcome, Sandy!  

Sandy Brown: Thank you, thanks for having me CJ.  

CJ: I'm so excited to have you on and everyone that's listening, you're all going to learn what an expert Sandy is when it comes to things in compliance and particularly coding and those sorts of things, she has great background and experience, and so we're excited to have you. We would like to offer our guests just a moment at the beginning just to tell us a little bit about yourself, professionally, where do you come from? What have you done? What are you doing? those sorts of things.  

Sandy: Great, yes, and it's always so odd when we have to talk about ourselves, right?  

CJ: I know.  

Sandy: But it's kind of fun too because I think about where I started and where I came from, and hopefully this might be encouraging to others because I definitely did not take a traditional path. I knew very early on, in my high school days even, that I wanted to be in healthcare, so I actually took a CNA class in my high school program. So, when I graduated, I actually was a CNA and was working and loved that side. I actually started out as a CNA and then I knew I wanted to get further into healthcare and continue my education. But I also didn't think like that nursing was completely for me. So, I went back and got my EMT and actually I worked for many years as both a volunteer and then a paid EMT firefighter and did it for about 10 years in Nebraska, which was so fun, and I met so many incredible people and just had some good and some bad experiences, but definitely some life lessons. I really think I've had, probably a balance or a pretty close balance of working in the hospital and working in a physician practice. Probably the last 15 years or so, I've been more on the consulting side where I try to help folks be able to identify issues and be able to have an audit done and then education. Education is definitely where my passion is. I love to be able to share the information, along the last 34 years, I've been able to gain that information and to just be able to share it with everyone. So, kind of a diverse background, but yes!  

CJ: Yeah, I was thinking, no one really kind of comes from a very traditional path, I don't even know what the traditional path is to what we do, right? It's like you grow up as a kid and you're like "I want to be a ....," well, maybe in your case, a firefighter or a policeman or whatever, who wants to grow up and be in Compliance and coding and no one knows about that, so it's kind of funny how we all end up in the space, but some of the things you mentioned make me think, "Yeah, I understand what you say, you like to educate. I love to educate and so I could see why that kind of skill and passion definitely draws those types of people into these fields. 

Tell us Sandy too, a little bit about your coding, like any certifications and those sorts of things that you have too.  

Sandy: I am really in the mindset of the lifelong learner. So, as I progressed through my career, I kind of had to take a, my education at least, took a backseat while I was kind of raising some children, and then because I think I may be a little insane, I decided to go back to school when I had three children, the youngest was ...  

CJ: Oh, my goodness!  

Sandy: Right! ... six months old. And here I am working full time, but let's go back to school, sure, why not? And that's really where I learned about health information management because I went to a small college, a community college in Nebraska that had just started this program. It was an incredible program because they had satellite sites, which at that time was just unheard of, we barely had Internet and so it was crazy!   

CJ: Exactly right.  

Sandy: Yeah, like I had to use my boss's e-mail address to send my instructor an e-mail which was just mind-blowing to me. And you think back and you're like, Oh my word! We were really behind the times, but at that time that's the way it was. So, I finished my associate's degree in HIM and then just really began kind of collecting and furthering my education. And now I have, I think about 10 certifications, both on the physician side and on the hospital side, especially on the outpatient, that's really where I focus. I don't do the inpatient anymore, I just decided it was too much to try to do it all.  

And then a few years ago I decided to get really adventurous and finished my bachelor's in Healthcare business administration. Took a year off, I think I got bored and then I said, "Oh, I might as well just get my master's," which if people knew me, they would just know that was never anything I would have aspired to do it. Just I don't know why, I was like, "Well, I did the bachelor's, like I can do the master's" and yeah, so, I went through CSU Global, they have incredible programs and such. They were kind of before the pandemic and before everything and everyone had to pivot and go online, they were already online, which when we travel and so forth, it worked perfectly for me to be able to go to school and still be able to travel with work and do my work and do my classes in the evening, post on the discussion boards, write my papers on the weekends and such. So, I graduated with my master's in Healthcare business administration with an emphasis on population health a year ago this past December.  

CJ: Wow, congratulations, that's awesome!  

Sandy: Yes, yes.  

CJ: That is so great and I wanted to ask some of those probing questions because I think it's going to play in a little bit into what we want to talk about today, which is kind of coder education, furthering education, lifelong learning, resources, programs, and those sorts of things. Our listeners, it's mixed, right? We have a lot of compliance officers and compliance professionals, But also we have auditing folks and coding, billing, and that sort of thing. What would you say to those folks who maybe are just beginning? You have the luxury now of looking back and saying this was my path, but you probably didn't plan out that path step by step. It's more of a journey, right? I mean, what would you say to somebody who's just beginning that wants to get into this? What kind of advice would you give them?  

Sandy: And you're so right CJ. It just was never in my dreams and I tell people that sometimes when I do presentations, I'm like never in all of my years would I have thought I would be standing here doing a presentation, or that I would be here with you all today that just was the furthest from my mind and that's where I think that we want to be able to aspire and set goals and think about what do we want to do. Once I discovered the whole passion that you can get and just the endorphins, I think that you get from standing up in front of a group of people and sharing the information and that energy that you walk away with, I was hooked.  

So, folks just getting into it, I would say, "Learn all you can.” I know both of us teach for the AAPC, I tell my students, "Soak everything up, soak up like a sponge, just really try to absorb anything that you can.” And it's even things like; the workflow in the clinic or the process claims have to go through or anything like that, soak it all in because it truly is helpful when you're trying to think about getting claims out the door and you're trying to think about clean claims and you're wanting to code or you're wanting to audit.  

Then thinking about some of the educational opportunities, I know I've had students in the past, or I've done presentations where folks have kind of gotten into coding, maybe they got in through billing coding, they were like me that I worked at the hospital and they handed me the coding book and said, "We'll send you to some classes!" when they come around that's literally, I had to drive to Wyoming to go to my first coding class.  

CJ: Oh, my goodness!  

Sandy: So, that kind of shows you the remoteness of where I lived and so forth. I shared that because I tried to be a little sponge and tried to really soak it all in and I think that has served me well. Not that I've had a perfect career or that I had this plan that miraculously morphed, I've had to work hard as we all do, and I've had to learn things like good communication skills too, being able to talk with providers and have conversations with them in a respectful manner, and thinking about how are these changes going to impact them or what could be going on in their life, those sorts of things, but definitely thinking about if you have taken maybe a route of just getting the CPC, and not that I'm discrediting that, but along the way, and as our guidelines have changed, we definitely have noticed some opportunity for folks to learn more about anatomy and physiology, if you didn't ever take that class in college. We're learning about disease processes, that was one of my very favorite classes in college to learn more about it and think about the medications and so forth, that's really, I could go on and on. But that is really where you can think about what classes could further me and where are my weaknesses. I think many of us including myself, I try to think about where my positives are right and where my strengths are, but I really need to focus on where am I weak and where do I need to think about, you know, really firming up my knowledge and expanding my knowledge.  

CJ: Yeah, those are all good points and I loved what you were saying when you were talking about speaking to providers and trying to think from their perspective, what's going on in their work life and those sorts of things and what came to my mind was really what you were saying is it's like customer service orientation, right? Like in encoding the stuff, it shouldn't be a battle. You should realize that whomever you're trying to help, they're your customers, so to speak, and you want to make their life easier, right?  

Sandy: Yes, yes, absolutely. And I know one of my friends, Kim Huey, if she's talking to a provider and they seem to be a little challenging and such, one of my favorite phrases that she shares is that she will reach out to them and say, "help me understand this," because then you get their perspective on what they're trying to do, or you're getting their perspective of what their challenges are. Maybe they're having to stay late every night, they're missing time with their kids, time with their family, all of those sorts of things, to try to get their documentation done, or they're struggling in different ways. So, that really helps us. Humanize this, and remember that we're all in this together and we're all on the same team. And I know sometimes it can be frustrating and I've had those challenging providers where I was like, oh my word! But we can be really calm and really seek that information, I've really found it to be so beneficial and you can even establish relationships where I never thought that this particular provider and I would see eye to eye, and what do you know, they came around! So, it’s wonderful when you can see those things transpiring as well.  

CJ: When you were talking, it reminded me of an experience I had many years ago where I was trying to provide some coding education to a provider, he was an internist, after I had done a standard type of regular audit, type of thing and we got into talking and he had some of those frustrations that you just mentioned like, "Man, this documentation just takes me so long and that's why I don't do this and this that you're asking me to do." And as I just sat and listened, this was kind of before the day of really sophisticated EMRs, but this provider did have like a kind of rudimentary EMR. I said, "Well, tell me about the three or four types of patients that make up 80% of your day," and he then went through and he said, "Yeah, well, I see diabetics and they have this, this and this. I see this condition with thyroid. I see this, this, and this," and so it's like, "Okay, so those three or four patient types you just described to me that represents like 80% of your workload. What templates we can use? What smart text we could put in so that we make the flow of your documentation easier?"  

Sandy: Yes! 

CJ: And we did it in a way that we weren't trying to gain the system and just boost up the volume of documentation, we're doing it in a compliant and healthy way, but it really made a difference to him. And that provider, I was with that organization for like seven or eight years, and that was early on. And by the end, that provider was always calling me and asking me questions about, "Well, how do I do this? How do I do that with the coding? How do I do this?" So, it had shifted from a relationship where I had done an audit and had to go out and supposedly teach the doctor something to one of, we kind of came to a mutual understanding of what the problems were. I, sincerely, tried to help him. It seemed to help him with his documentation and then there was this relationship of trust and then now you've won somebody over and now they're coming to you instead of you feeling like you have to go to them.  

Sandy: Exactly. And I know we had a very kind of similar situation recently too, CJ. Where we went to meet with the provider and her score was not good. And we were kind of also trying to seek to understand, as to what were some challenges, what was going on with her, and immediately she was on the defense, she was tearful. And I felt horrible. In fact, I just said, "Let's just go ahead and call this. And we'll reconvene." And so, we talked with leadership a little bit and so forth, then late one Friday afternoon, because that's what time worked for her, I got on the call with one of her leaders and herself, and in the manner that we approached it, it was a little bit more laid back. I introduced myself again and I just came about it and explained why we were doing these and that we were here to help them to identify any potential issues and to get that baseline. And I tell you what, her attitude completely changed, and in fact, I said, "Oh, this won't even take half an hour," we were on, it was over an hour and I just kept thinking, "Okay, I've got to wrap this up because I've got other things to do too." But it was so awesome. And now I refer to her as like she is almost the golden child because she got it, she listened to us that second time that we talked to her. And she is like our champion now that we want her to even do some of the training and so forth because she just changed and it was incredible to me to see the transformation with her.  

CJ: Yeah, that's so awesome. Sandy, this is great. We're at a point where I'm going to just have us take a short little break and we'll be back in a few moments in a few moments, folks.  

CJ: Welcome back everybody from the break, again I'm CJ Wolf. I'm here with Sandy Giangreco Brown and we've been talking about coding, careers, and some experiences we've had with providers and those sorts of things and kind of combining this coding world and career and improvement in education.  

Sandy, I wanted to ask you a little bit about what kind of programs or resources are out there for people who are wanting to, even if they're at the beginning, middle, or late in their career, what kinds of things are you aware of that might help people do this continual learning that we've been talking about?  

Sandy: I think there's always opportunity. One thing that I have really heard and noted, I think in the past couple of years too, is getting yourself a mentor. So, that's something too that I would mention, that can be incredibly helpful, have someone, it doesn't have to be someone that you work with, it could be someone in the industry that they do what you want to aspire to do someday, so you can talk with them about, "This is how you could potentially get there, and here are some of the steps you could take and go along the way." And sometimes, you might need to further your education, if you want to get into a managerial position and so forth.  

Like it or not, at this point, most facilities and most places are going to ask that you have a bachelor's or a Master's or something of that kind of equitable. I would say there are many programs out there that would be very valuable and you get things out of them that you wouldn't anticipate, such as; communication and being able to communicate with people, especially if you don't necessarily agree with their opinion.  

CJ: Exactly! 

Sandy: Yeah! I cannot tell you how many times I had to post on someone else's discussion board. And it wasn't just like a Facebook post that you would do. It had to be very intentional. It had to be very thoughtful and we had to of course have resources cited in the post. But we also had to be respectful. And there were times that I absolutely did not agree with the perspective of my fellow student, but that was an opportunity for me to think about, "Okay, how can I politically correct and politely approach this and just say I actually have a differing opinion and here's how and why," because we all come from different backgrounds.  

So, there's that opportunity that I feel really helped me grow, as a professional and in my ability to handle conflict and such. 

There are also programs, a lot of your two-year community colleges, and so forth that you may have right in your neighborhood, could potentially have a nursing program or they have an HIM program, and if that is something that interests you like I was referring to the disease process class the anatomy and physiology, you can take a lot of those and talk about reasonable tuition. It's going to be very cost-effective and beneficial to you because we cash-flowed my master's and even the end of my bachelor's so that it wasn't that burden, we didn't want to have that burden either financially. So, I always try to encourage folks to see what kind of scholarships or grants they can get as well. See also if your employer has tuition reimbursement.  

CJ: Exactly! 

Sandy: Yes! and I know for a while, part of my degree, that's I think why it took me so long on my bachelor's was I was working at a place that offered tuition reimbursement, but I could only have like 2 classes or three classes a year, due to the cost, so I just spread it out and I was able to do that, but then it isn't as cost prohibitive. So, just be creative with that, talk to the admissions folks about that.  
And I talked about being a lifelong learner, I saw yesterday someone posted on LinkedIn about a telehealth certification that you can get that you basically just add on to your master's.  

CJ: interesting! 

Sandy: Yeah! And I'll send anybody who wants the information they may fill up their program, right? Incredibly affordable, I'm talking $150 for the whole program and it's like 5 weeks and three classes or something, I can't remember. But I was astonished at this. And I'm thinking, "Well, this would be fantastic because telehealth isn't going anywhere." So, it's those sorts of things that we want to continue to learn and be on the cutting edge of things and be knowledgeable about new procedures, that our providers can be doing, or nuances; telehealth, whatever it may be, so that we can help our providers and our facilities or our practices be compliant like you were saying CJ and also make sure that the documentation is supporting the services that are done and that it's reflecting and it's capturing all of the required elements. 

CJ: We we've mentioned HIM a couple of times and I don't know if we defined it, but it's health information management, right?  

Sandy: Yes. 

CJ: There's a lot of programs out there, and those types of programs are usually what they're either two or four-year type of programs. 

Sandy: Yes, yes. The two-year program is actually one that I went through. Then, once you complete that then you are RHIT eligible, Registered Health Information Technologist. RHIT eligible, so you can then go sit for your exam. They have sites where you sign up and you have to pay and send in your transcripts and you have to be eligible to take that, and then for the RHIA, that's more on the administrative that's the Registered Health Information Administrator. And more on the managerial side a lot of your large hospital systems will have an RHIA on staff and as the director or the VP of Health Information Management and that is really what that degree is intending to do is that you can manage that department and think about the statistics that you compile for the state and for the facility and so forth. One of the things that, the advantages that we have in this day and age, is that a lot of these programs would be online too. 

CJ: Exactly! 

Sandy: Yes. I know when I took my RHIT, some of it was online, some of it was, which was really cutting edge back in the day because I graduated in like 1999, so that was very cutting edge for them, and they also had satellites where they broadcast it to three or four different sites in Nebraska. So, it was really cool and I think it was hooked up through the University of Lincoln. But there are so many different programs around the country and many of them are going to be online. I always encourage folks to make sure that it is an accredited program, meaning that you will be able to sit for the RHIT or RHIA at the end. And you can always add that on, and just keep adding on, as I tell folks, “Add on the alphabet soup to your name and really expand your knowledge and show your proficiency.” And that really does give you credibility as well, when you're talking to professionals, you're talking to providers, you're talking to other coders. That really will get you that, hopefully, get you that respect, but definitely the credibility that you've taken the time too, that you've invested in these programs too.  

CJ: One other thing I was thinking of, it's you kind of need to decide do you want to kind of go a very formal kind of accredited route like you're talking about and that's appropriate in some circumstances, there may be some people too who don't want to do that kind of commitment but they still want to. There are a lot of people out there who are self-learners, they just want the information. One thing and I don't know if you're familiar with this and there's a bunch of them out there, but there're what is known as massively open online courses, where universities will post their content from their courses, and you might not get university credit for it. One such organization is called Coursera and like if you're interested, let's just say you're interested in neuroscience and you wanted to learn about it, they have 12-week courses and you can take it, like MIT or the University of Michigan, or Yale. They'll put out their course content, and you can kind of, at a semi-self-directed pace, you can listen to the lectures, you can learn that information. You can even do it completely free, but you can also I think pay a little bit of money, it's like $50, and you can get like a certificate at the end saying I completed this course and those are online and they're very flexible if you're busy like you were saying, you had a 6 month old and had children and working full time and you're just trying to fit learning in wherever you have time. Have you ever used any of those courses or heard of those types of things?  

Sandy: You know I haven't CJ, but when you mentioned part of it and so this is new to me, which is exciting. I'd love to learn too. I think my husband did. He's in education and I think he might have used one of these, even during the pandemic, because they were also trying to kind of stand up within the school district. Some of the new programs and so forth and he does coding when we think about coding robots and such. So I think that name sounded very familiar when you mentioned it. 

CJ: Yeah, it's called Coursera, and there's a bunch of others, I'm just blanking on the other names. I do some work in higher education and one of the big movements is called Open Educational Resources. There's just this groundswell of feeling in education that if this information is available, why can't it just be available to people if they want to learn it? And So what Open Educational Resources are, is they're published under what's called the Creative Commons License, which allows you to basically, as long as you give attribution, you can tweak the work, you can redo it, you're just giving attribution of where the foundational work came from, but all sorts of universities are publishing, like anatomy books that are just open, they're open resources, you don't have to pay for them, you just download them online. So the reason I'm kind of going through this is for our listeners, some of you out there like the formal kind of formal path, accredited and that's great and some might not be at that place where they want to do that, they just want to learn from these other resources. So, there are so many great resources out there.  

Sandy: Those are great CJ and I'm going to go look those up. That's fantastic.  

CJ: Yeah, they're fun. I just started one on evolution because I wanted just to freshen up on my I just, intellectually curious, sometimes on different things, it's a lot of fun.  

Well, Sandy, we're getting a little bit closer to the end of our time here. What did I not ask you? Or is there something that you want to talk about or say kind of in this general area that we've been talking about that I didn't bring up? 

Sandy: Yes, one of the things too, CJ and I think I got so excited about just talking about some of the programs and such, I may have failed to mention, and I've seen this topic a lot recently out on the APC Facebook page too, of thinking about, "Well, doggone it. I got my CPC or I'm very new to this, I can't find a job, I don't know how to get my foot in the door." And one of the things that I know, some of the other instructors have been sharing, and I tell my students and I have been for years, "Get your foot in the door any way you can," you may not be able to fit the job description of a coder right now because you don't have the experience, or maybe they want you to have more healthcare experience, but get your foot in the door as a receptionist or as a scheduler or anything like that, because you're going to gain so much information about the facility, about the process, and that truly will help you, it may sound silly, but it truly does help you to be able to think about, "Okay, I know that when patients present, this is how they present. This is how we make their medical record," - Okay, so I'm showing my age with the paper medical record, right?  
But I know that we check them in, this is how we do things. We have to have the H&P prior to the patient having surgery. All of those different elements and that can really help you to understand then, "Okay, I'm missing an H&P or I'm missing this, or whatever that may be."  

It also helps you to develop those relationships by getting your foot in the door, and that may be at a small clinic, it could be at a hospital, if you're in the rural areas, look at the FQHCs, the federally qualified healthcare centers, or a Rural Health Center, an RHC, because the sky is the limit and a lot of times they're having trouble filling those roles and those positions. So, if you have, for instance, you've gone through your CPC, you have your apprentice and you're walking through the practicode and you're trying to get rid of that, but that might be a great way for you to get your foot in the door, show your hard work, show your detail-oriented, all of those different elements and then you can start those conversations and you never know what doors that can open.  

CJ: You are spot on when you were talking, I think that's so smart. And then once you get your foot in the door be a sponge and soak everything up. Early on in my career, I worked for a large healthcare system and there was a gentleman, a young gentleman who was a security guard and he was at the front desk of the main atrium, in a very professional type of office setting and every morning we would walk in and he was so outgoing and so friendly and so nice. And we happen to be doing a training course to get people ready to pass their CPC. And over the months, we had talked to this individual and got to know him a little bit better. He was just outgoing and always was like trying to learn. And we said, "Hey, I don't know, you interested in this course? Oh yeah, that sounds really fascinating." He took the course. He became an outstanding coder and leader, and now he's a director of a large department in a healthcare system and it's just like, he probably didn't take that security officer job thinking he was going to end up in coding, but you know, let life direct you a little bit, and just be the best person you can be.  

I had a mentor that always said, "You interview every day." So, what she meant by that was, a job opens up, and this person you've known for three years, all of a sudden pulls out his shirt and tie and comes to the interview. It's like, "you don't dress like that. I've seen you for the. Last three years. You don't do that." So, what she meant by that is every day of your life you're interviewing. You're demonstrating to people, your work ethic, your attitude, your positivity, and your learning desire, those sorts of things, and so when you were talking, that's what kind of came to my mind. 

Sandy: Absolutely, and I love that story, CJ. It's so cool when you see people, who you never would have thought, "Okay, you know, don't be a coder, don't be a coding director" and I love that. I think so often, we may be down on ourselves, maybe people have told us that we can't be this. Well, you know, you can be this and you can do what you want to do by following these steps and being a sponge and learning all of these different things it can just it can be so beneficial to people.  

CJ: Spot on Sandy.  

CJ: I really appreciate you taking some time Sandy to be with us. We've kind of come to the end here and I just wanted to thank you one more time for being our guest.  

Sandy: Absolutely, I am happy to, and it's great. One other quick thing I would say is– Network, you know, network in this industry and get to know folks.  

CJ: Oh, good one, yes.  

Sandy: Create a LinkedIn and get connected with people, because you can learn so much by reading articles and such too, so much great stuff out there. 

CJ: That's such a great one, and as you said that, I'm also thinking of conferences as you participate, either virtually in conferences or in person. Get to know people, and connect with them. Most conferences now have apps where you can reach out and make connections and so just as you said, networking and network like you're a sponge and learn like you're a sponge. All the things you said were spot on.  

Sandy: Yes, that is so awesome and this is such a cool industry. I really love what we do. I'm always so excited when new people are joining or we can encourage folks, so thank you again for having me CJ.  

CJ: Absolutely, and if it's okay, Sandy, I think people could find you on LinkedIn and I know that you've been very active there and have been kind to others. And so, I know that you probably would welcome that kind of contact. 

Sandy: Absolutely. I feel like people were that way with me and if we had more time I could go on and on about people who, whether they knew it or not, and whether it was good or bad, they mentored me. But that's part of it, is we all have to give back and not that we have to, we want to give back and we want to be able to see other people progress and get into this industry and learn and a lot of it is just learning how to navigate through things network and learning more about the industry. So, I very much welcome it. So, thank you!  

CJ: Thank you for sharing that and it does, you're right, it makes life joyful when you can give back and see others grow and that makes it all worthwhile.  

Well, Sandy, thank you again, and thank you to our listeners for listening to another episode of Compliance Conversations. We hope that you liked this episode. If you did, please hit the like button and please subscribe so that you don't miss future episodes and share them with your friends. And thanks again for listening until next time. Take care! 

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