Retaining and Recruiting HI Staff: Beyond Competitive Salaries and Benefits

Health information (HI) professionals are in short supply. As health records have digitized, demand has surged for the professionals who manage them. 

The Bureau of Labor Statistics projects that employment of health information technologists and medical registrars will grow 17 percent from 2021 to 2031, much faster than the average for all occupations. 

Industry leaders are responding to this shortage by reducing turnover, encouraging professional development in their organizations, staying up to date with new tools, and exploring new recruitment methods and technologies to help land qualified candidates.  

AI, the Pandemic, and Education's Impact on the Labor Pool 

Experienced inpatient coders, who have specialized skillsets (compared to outpatient coders), are in especially high demand, with experts indicating that recruiters can take up to nine months to fill these positions. 

Despite evidence to the contrary, many people still believe that technology will completely take over coders' jobs. As interest in computer-assisted coding, artificial intelligence (AI), and machine learning grows, universities are responding by promoting data analytics degrees over medical coding certificates, perpetuating the myth that medical coding is no longer a viable career path. 

While AI is useful, it's not foolproof, says Diann Smith, MS, RHIA, CHP, FAHIMA, vice president of health information management services and clinical documentation integrity at nonprofit health system Texas Health Resources in Arlington, TX. 

Health systems still need coders who understand medical terminology and have an understanding of the disease process, i.e., pathophysiology, particularly in handling exceptions and complex problem-solving. "Even with technological advancements, there is still a need for validation and improvement in documentation, which drives the coding process," Smith says. 

Before COVID, medical coding stood out as one of the few careers allowing individuals to work from home, but now many industries offer remote work options. Smith says some organizations are also outsourcing their coding work to US-based agencies that use labor from other countries, further shrinking the US labor pool of coders, which was already weakened by widespread retirement among the Baby Boomer generation. 

Together, these factors make it even more difficult for health systems to find qualified health information management professionals. 

How to Better Recruit and Retain HI Talent 

Healthcare leaders may be overlooking their most significant asset when finding and recruiting new employees: their existing workforce. 

"Internal employees can be a great resource because they can bring their friends along with them," Smith says. "If I work for an organization I like, I'm going to spread the word about it." 

To encourage this word of mouth, Smith says employers should consider offering referral bonuses to existing staff, incentivizing them to share job opportunities within their networks. 

Key to effective word of mouth are happy employees, Smith emphasizes. For example, Smith says offering competitive compensation and benefits is crucial for recruiting new employees and retaining current staff. Employers should conduct annual market analyses to stay informed about industry standards. Especially in today's market, providing additional bonuses based on key performance indicators and offering sign-on bonuses to new hires can also give companies a competitive advantage in retaining and attracting top talent.  

Culture is equally essential, Smith adds. Leaders should frequently communicate with teams to promote morale, especially in remote work environments. Encouraging internal professional development, strengthening collegial relationships, and investing in employees help them to feel valued, which can also be instrumental in reducing turnover. 

"If you don't have a great culture, people won't stay," Smith says.  

Finally, Smith says employers should broaden their candidate pools by expanding their recruitment efforts to other states. Organizations that try all of these approaches simultaneously will have an advantage in attracting and retaining the best talent. 

Providing Creative Fringe Benefits 

Natalie Novak, MHSA, MBA, RHIA, corporate director for the health information management division of Indianapolis, IN.-based hospital system Franciscan Alliance, encourages health system leaders to be creative when designing benefit packages to retain valued staff. 

While she lists tuition reimbursement, paying for industry association dues, and funding employees’ continuing education hours among reliable ways to instill loyalty in the workforce, she says that ensuring staff has a voice in their work is just as important. 

For example, Novak recommends leaders create focus groups where coworkers can share feedback about what they like or don't like in their jobs and offer suggestions for improvement. Forming an activities committee, sending employee engagement surveys and hosting department-specific town halls can ensure staff feels heard while giving leaders valuable information to help improve their culture. 

Novak also suggests that leaders offer staff opportunities to connect with their colleagues and grow professionally. They can do this by allowing staff to shadow other positions, encouraging employees to participate on workforce committees, or connecting them with professional boards. 

Finally, recognition is crucial to retention. Novak notes that simple gestures including milestone anniversary celebrations or coworker and leader recognition awards can make staff feel valued. 

Cross-collaboration Leads to Professional Development 

Experts say leaders can boost retention—and improve patient care and operations—by encouraging HI staff to grow within their current organizations. 

HI professionals have versatile skill sets and often excel across quality, revenue cycle management, privacy compliance, and other departments. While these staff have historically pursued medical record coding and human resource management, many opt to expand their expertise on the job.  

Health systems looking to implement a career ladder for HI staff can start by encouraging collaboration between their chief medical information officers and chief analytics officers, who can help identify opportunities for cross-collaboration among staff, says Kristen Dubesky, MS, FACHE, chief analytics officer for Penn Medicine Lancaster General Health (PMLGH), headquartered in Lancaster, PA.  

For example, clinical data abstractors at PMLGH not only analyze and submit data but also look for improvement opportunities, working alongside operations and telehealth departments to build their electronic health record to capture data more distinctly. Teams responsible for submitting data related to specific quality measures may also notice patterns in readmission rates once they understand the system’s data workflows, Dubesky says. 

PMLGH abstractors, who are responsible for extracting critical information from medical records, can move up to become coordinators, with increased opportunities for improvement across different areas. The highest level of coordinator is a registry coordinator, who monitors multiple types of registries and facilitates cross-collaboration. As individuals gain experience coordinating and working with data and metrics, they can become healthcare data analysts responsible for analyzing various data beyond medical records, such as patient satisfaction and productivity data. These analysts also understand workflows and work with customers. 

While some incorrectly fear that AI is replacing medical coders, others say that organizations need AI to keep the coders they already have. 

For example, as staff takes on more right-brain thinking, health systems must evolve their resources to keep up with advances in technology and AI, Dubesky says. She adds that they should fine-tune their workflows, automate processes, and become more diagnostic to avoid losing talent. 

By continuously keeping resources up to date, encouraging cross-collaboration, and generally creating a culture where staff feels engaged, rewarded, and heard, healthcare organizations can reduce turnover, attract more employees, and stay competitive in an ever-changing healthcare landscape. 

"If you don't have that evolution of your resources to become more analytical and to continuously improve your workflow, you will lose people," Dubesky says. 

Genevieve Diesing is a Chicago-based freelance writer with nearly two decades of experience writing about everything from hospitals to healthcare policy, health IT, DEI, and financial market shifts. As a healthcare journalist and content writer, Genevieve has worked as a staff writer and editor at Hospitals & Health Networks magazine, and written for national publications including The Atlantic, Elle Magazine, and the Chicago Tribune.