On-ramps and routes to Health Information Management

We talk with Accuity's Vice President of Revenue Cycle Operations, Jennifer Miecznikoski, about health information management careers and how an HIM foundation can lead to operations, IT, analytics, and revenue cycle leadership. We break down credentials like RHIA, RHIT, and CCS, then look ahead to AI, data governance, interoperability, and HIM paths allowing growth into management roles. 

• Jennifer’s career path from foundations in HIM to leadership of EHR implementations 
• Emerging and expanding HIM career roles
• How DRG integrity work pairs coding expertise with physician review 
• What RHIA and RHIT signal for leadership and technology paths 
• Why CCS and other coding certifications build credibility 
• A practical tip on taking credential exams sooner 
• Where AI, computer-assisted coding, and data governance create new opportunities 
• Advice for moving from coding into leadership through mentoring and research 

If you have any questions or would like to offer a topic to discuss, please email info@accuityhealthcare.com

Transcript

Welcome To Chart Check

SPEAKER_00 0:02

Welcome to Chart Check, Clinical Perspectives for the Middle Revenue Cycle. This podcast delivers insights that drive impact in healthcare information management. Stay current on clinical knowledge, coding updates, and industry trends through expert interviews and conversations with Acuity Zone physician, CDI, and coding leaders. Today's guest is Jennifer Miznikowski, Acuity Zone Vice President of Revenue Cycle Operations. As a registered health information administrator, she brings expertise in healthcare operations, clinical documentation, and revenue cycle management. Welcome to the show, Jennifer. Thanks for joining us.

SPEAKER_02 0:37

Well, thank you for having me on the podcast.

SPEAKER_00 0:39

We're hoping that to talk to you a little bit about your perspective and thoughts on coding careers and also a little bit about how you came to be uh the position you're at.

Finding HIM By Accident

SPEAKER_02 0:50

Sure. Um more than happy to share. I have been in the HIM field for actually since about 1999. I came upon being in the HIM field, which used to be called medical records, um, kind of by accident. I was able to pass a filing test for a hospital. At that time, that was basically to be a general clerk, all you need, you know. So I went into medical records and found that it was the career for me. And as I kind of moved along, so uh prior to that, I was administrative assistant. So um in my HIM field, this kind of goes into the different, you know, areas which you can be in. Now, I am not a coder. Um, I manage coders, and there are, you know, many, many different aspects of coding um in the HIM field, and even not so much in the HIM field that coders can go into. But for me, um, I chose not to go the coding way and became what we used to call in the olden days a secretary or HIM director, uh, which taught me quite a bit. Um, and I was also, as part of that, believe it or not, the medical librarian.

SPEAKER_01 2:06

Oh, yeah. Yeah. Yep.

From Paper To Scanning To EHR

Nontraditional Coding Roles At Acuity

SPEAKER_02 2:07

So working with physicians, yes, um, you know, with all of the articles. So my my experience is quite, I would say, varied. Um, and from there, in the same hospital, I, like I said, we started with paper records. And um, as part of my uh career progression, I went into um system administrator of our post-document scanning system, which then in turn uh moved me into information technology at the same hospital. So just to kind of show, you know, how that worked. And because of my information technology experience, um, I had the opportunity. This was all in California, by the way, that's where I'm from. Had the opportunity to move to um Maryland, working for the University of Maryland um as assistant administrator for their movement and transition into post-document scanning. Yes. So that's kind of how I started. So it was like paper records, which were, you know, a lot of fun. Um very manual. Yes, took a lot um into post-document scanning and then into um EHR. So then I worked for um Optum, which I went in and, you know, assisted with their Cerner implementation um across their um one of their clients. So that's how I came to Acuity. Someone that I worked with at Optum said they needed someone at Acuity. And here I am, started out as director of operations again, um, just moved through. And again, this is really how, you know, someone in the HIM field can, you know, spread out. You don't have to like think of, oh, I'm gonna be a coder, which a lot of people do, you know, I'm gonna code. Now, some people like to do that, some people are great at that, and we need those. They have a very specific skill set. Um, but with that skill set, you can also do other things. So, you know, even at Acuity, director of operations, I then went into implementation. Um, I was in reporting and analytics, and then I went into process improvement and to my current role. So I've been at acuity almost nine years. So, with that again, you kind of move into the different areas. And really, my HIM background is what allowed me to kind of move into each of those. I chose not to be a coder, you know, a lot of people do. Um, but again, we have a lot of coders. We have coders that work on our team here at Acuity. When we first started, we did have the traditional coding where you discharge, we do the traditional coding, it goes through, then it goes through our, you know, acuity process. We um don't do a lot of that anymore. So most of our coders, we used to call them query closers. Um, and it was very different again. It does require that you have, you know, a very strong um coding background, you know, inpatient. Again, that's what we do here. Really, what they would do is look at query responses, look at the chart, um, and then code it appropriately or send it to our clients for, you know, as a recommendation. So again, that's outside of kind of what a traditional coder would do. We also have what's called revenue cycle analysts, which again is outside of it's similar to what if you worked, let's say, in an inpatient hospital setting, um, where you would, you know, kind of follow up on physician documentation, you know, what we would call chart completion back in the day. Um, but really what these people, all of them now are required to have a credential, whether that's the coding credential through AHEMA or AAPC, um, or um the registered health information administrator, which is what I have, for registered health information technician, which is the two-year degree. So we're one of the, I would say, it's different in a way where um HIM does have very specific degrees. So we have a four-year degree, the administrator, and a two-year degree. But then you also have certifications, um, such as the CCS, that you don't need a degree for. You do have to have a certain, I would say, apt for, you know, sitting and really getting into reading charts and a lot of anatomy and physiology. So coders as well, you know, have quite a bit of not in the same, you know, aspect as physicians, but just by reading charts, coding them um quite a bit of clinical knowledge. So that also goes into, you know, what they can do. At Acuity, we have what are called DRG integrity, our DI specialists is what we call them, which are paired with a physician. So they sit with the physician, you know, review the charts from a coding and the physicians from a clinical perspective, and they make a great team. So again, at acuity, we um have they're all required to have any of those credentials that I, you know, talked about before. But you know, it's it's not in a traditional setting. So it is different. Um, so really in the HIM world is what I call it, health information management for those that um don't know. Us, you know, we always have all these acronyms, and I think we all just kind of say, oh, everybody should know what that is. Um but it's health information management is kind of what what we call that, you know, whether you have your release of information, which is also in our world called ROI, which, you know, in the um financial world means something different. Um, so you know, it's it's quite a bit, you know, all these little acronyms, but there's a lot to do within the HIM realm, either in a traditional setting or non-traditional. So for example, and you know, I'm not plugging AHEMA, but AHEMA is our governing body. It's American Health Information Management Association. There is a credential for, you know, a certified data analyst, and we have um some of those here at Acute. So as people are looking, you know, at different careers, you know, data, we have talk about AI, you know, that's something you can go in as well because it's really important to have that foundation of, you know, what um coding, for example. So, you know, you have DRGs, you code, you know, you send out that out, the claim out. Um, but you know, you really have to have all this background because the reporting is so important. And acuity itself, being, you know, a data-driven organization, data is very important. And it does take someone that understands kind of you know, the um inpatient prospective payment system. Again, IPPS. All these different yes. Um, to really, you know, um be able to build reports, understand what's being reported. So again, that is an HIM professional. So I think, you know, I've talked a lot a lot of acronyms and kind of what I see as doing. And again, there's so much more that I haven't even discussed. We also have cancer registrars, which most of the time are part of um the HIM world. Um, it's a little different than we are. Birth registrars, believe it or not. Um, when I worked in California, that was one of my duties to make sure birth certificates were filled out properly and registered with the state. So yeah, there's, you know, all kinds of different things that I think a lot of people don't know in a traditional setting, non-traditional setting, kind of what we do. And, you know, I think that I'm obviously H I M, and I have been for quite a few years. I have a sister that's a nurse, um, a sister that's a physician, when my parents are explaining kind of what we do, and then they said, there's Jennifer, who we're not quite sure what she does. So you know, well, and because sometimes it's a little difficult to understand, um, because you know it is very specific. Um, and unless you kind of don't understand the HIM world, um, you don't really know, you know. Um, a lot of times I'll say, Oh, you know, when you go into a hospital and you ask for your medical records or you use a portal, you know, that's kind of something that's very similar in an HIM world. So, or coding. People understand coding, like, you know, the people that put the codes on and it gets to the insurance company and the claim is paid. Um, but again, like I said, there's so much more than that.

SPEAKER_00 10:27

We're lucky to have you at Acuity. I really appreciate your perspective. And it certainly um has blown me away that I coming from an academic background, I um am fairly new to HIM, and that just that first time you you pick up your um pocket guide to coding and realize that it's almost a legal library of breaking down, as you said, clinical, you know, scientific topics, but into this very uh kind of complex system to break them down for the coding. That it has been um really impressive to see the the breadth and depth of knowledge that's really required for uh these all HIM careers, but especially these centered on coding. But I'd love to hear a little bit more about um your decision to to to get the the four-year degree and and how you feel about RHIA versus uh the the two-year degree as well as the coding certificates, and if there's uh sort of recommendation or perspective on career paths and how each each one certainly can lead in in the same direction, I feel sure, but that uh there's sort of maybe on-ramps to to different uh styles of profession.

SPEAKER_02 11:37

Um there are. From an RHIA perspective, it's really more, I would say, you know, the administrator. So if someone, again, back in the day when I started, now I didn't get my credential, my RHID credential for quite a while. And the reason that I got mine was because it was required by a hospital that I worked at in order to, you know, uh maintain my job. So um, because it is important, you know, in our profession, it is important to have that, you know. Yes, you might have all the knowledge, but really to have, you know, the credential. When you look at an MD, you know, it'd be great if they knew everything, but they didn't have that MD after your name. Um it makes, you know, it gives a little bit more, I think, credibility to our profession. The RHIA, if you would, like I said, wanted to go into perhaps um an administrative role, whether that's a director, director of coding. Um, we all there's also a lot of you know consulting firms out there as well that have these, you know, for release of information, for example. The um administrators, management teams and the release of information um consulting firms, you know, they're required to have an RHIA or an RHIT. So RHIT um kind of has, I would say, moved into the direction of more technology-based rather than um when I first started out, it was more coding. But now they've really moved into the technology realm. So HIM is, you know, again, kind of at the advent of the technology. So, you know, as the used to be back in the day, the holders of the um legal medical record, you know, that was kind of what we did. Um, so if you had a record, for example, unfortunately, that, you know, for some reason was in some litigation, something again, I did. Um, you worked with, you know, your um legal department and those got locked away. So, you know, again, and it was our, we were the police of those to make sure that nobody could even physicians came in, we used to have to stand with them back in the paper days. Um, and you know, and so yes, I mean that's where you I start talking about all this. I'm like, wow, yeah, just think of all the things that we used to do. But then as we were moving towards post-document scanning where there was no physical paper record post-scanning or the EMR, where very few um documents are, you know, um scanned in. That technician piece is more technology piece from the registered health information. Um, so that's the two-year degree, um, you know, what you can get from a community college. Um, and then the four-year degree, you would need to go to obviously a four-year college. And I think it, you know, really made it easier when online courses started coming. So, you know, so um University of Cincinnati, for example, has a four-year degree. Stevens College has a four-year degree, you know, so there's a lot of different areas that you can get those where you don't actually have to attend anymore. So it again, it just really depends on where you are in your career, if you want to go for the two-year, if you want to go for the four-year. The director that I reported to for uh almost 10 years in California, she was an RHIT. Um, it wasn't required to have an RHIA. Uh, but California, for example, has as part of their um, you know, guidelines that anyone overseeing a medical record department is required to be, you know, an RHIT or RHIA. So, you know, because again, it's that credibility, um, because there are a lot of rules, a lot of regulations, um, state and you know, federal, um, that have to be adhered to. As you're looking at your career path, what do you really want to do? You know, do you want to be in data? Do you want to have, you know, a traditional role in um as a director? Uh, do you want to um, you know, be maybe in a non-traditional role at, you know, a release of information firm or something to that effect? So it really depends on kind of where you are and what you want to do. I do have one, and from a CCS perspective, so let's just say um CCS is a certified coding specialist, which is an ahemic credential, which the majority of our staff are CCS. And that really is, you know, the, I would say, the credential that, you know, people look for to say this person really understands coding, the CCS. Um, there's also, you know, AAPC that has, you know, something similar. And when they have those, it kind of gives that credibility of this person must know what they're doing because the CCS and even the AAPC courses, they're very difficult, you know, tests that you have to take. And, you know, again, they're very serious when you take these to get your credential. You have to go, they're all proctored. Um, when I took mine, you know, you go into one of these sites, um, they take your phone, you know, they make you hold up your hands and they have a camera looking at you. So, you know, it again, it's it's very, they take it very seriously, which it should be. That's kind of you know what I say. I do say though, if you're going to get these four-year, two-year degrees, or, you know, go through all the courses to get the CCS credential. My recommendation is take that exam as soon as you can. Because the more you wait, the less likely it is that you're gonna pass. Um, and you go through all that work, you should do that, you know, because again, it someone told me it's your ticket to the dance. So there you go. Yeah.

AI Data Governance And ICD Future

SPEAKER_00 17:18

Yeah, absolutely. Oh, that's a great perspective. Are there um any thoughts you have on sort of the the future towards uh trends in coding careers uh in HIM? Um is there an area that's exciting for you?

SPEAKER_02 17:31

Um sure. So I think as we kind of look back, computer assisted coding, like when that came out, um, there were a lot of HIM professionals that went, you know. So we have Solventum, again, HIM professional, um, work at Solventum and you know, kind of helping with kind of what goes on. They need that, you know, true subject matter expertise to help in a lot of these um data analytics. Um, you know, AI is something that's obviously everyone's talking about AI that can, you know, assist where, you know, it's um acceptable. So I really see there's also data governance. HIM professionals work in the data governance um field. Quite a few years ago, that was the up-and-coming um data governance, which again is very important. And it's not, again, not working in a traditional role. So, you know, there's a lot of things, I think, just as we move towards, you know, the technology um AI realm that would be exciting from you know an H GIM professional's perspective.

SPEAKER_00 18:33

Wow, I I love it. I I think you're absolutely right. It's um as you say, everyone's talking about AI.

SPEAKER_02 18:40

Yes, um, they are, yes. And you know, it's it's it is exciting, you know, but again, we just have to make sure that what we're doing is also credible. You know, you see things out on social media of attorneys that are using fixed cases and not knowing it. So yes, you know, it's very important that we're using credible sources and we're using it, you know, as as we should. Um, so yes, I see that for the HIM. You know, at some point, uh, well, let's see, in 2015, I believe, ICD 10. Um, there's been talk of, you know, ICD 11, which is going to be very different. Um, so, you know, people will be needed, you know, for their expertise for that as well. You know, I don't have any insight in when I CD 11 will, you know, come on board. ICD 10 was, you know, quite something. Um, but you know, it made it better. Um, more specificity, you know, not it didn't quite, you know, have the impact on productivity that, you know, uh people thought it would. But yeah, super exciting, you know, as you kind of move through all of these new developments, you know, most everyone interoperability. So that's another one. You know, you have just varying different, you know, areas when I'm saying interoperability, you know, each of, you know, people have, you know, different EMRs, EHRs. And really, as, you know, state by state or you know, even city by city within the states, it's very important that everyone has access to the medical records that they need, you know, to care for that patient. So that's something that HIM is, you know, involved in as well.

Moving From Coding To Leadership

SPEAKER_00 20:17

Oh, it's amazing. I think that uh that's another great uh callback to your point about credentialing, also, is that with the the rise of bogus AI results, that you need the um the the real expertise uh and all and hands-on human touch there. But um considering uh maybe um a final note, might be could you give some advice to um coders who are looking to move into a more of a leadership role? Um, like like moving into an administrative uh type of position?

SPEAKER_02 20:46

I do. So what I would really suggest is finding a good mentor, you know, finding a mentor and really having, you know, an idea of what you would like to do. Like I said, you know, if you have a mentor, for example, when I was in California, as I was moving into my new IT role, someone in that was coming in to take mine. And my mentoring advice to her was, you know, you've been working here for quite a while. You know, if you want to make this a career, what do you really want to do? So she became a coder. And, you know, so she really wanted to become a coder. So I have to say, you know, do research, find a mentor, talk to people that are in, you know, the um the profession and kind of just go from there. You know, coding isn't for everyone, but you know, there's a lot of different fields that you can go into, um, like our RCA, our analysts. Um, they have analysts, you know, in inpatient settings, you know, outpatient settings. Sometimes I think people have tunnel vision when they think of even an RHIA or RHIT that you want to work in a hospital. But acuity, for example, is you know, we have um, I have two RHIA credentialed, uh, one that has the uh surprise. Certified data analyst credential that work as uh we call them HIM data analysts. And they do a lot of the operational reporting specifically for my areas. Um, so again, you know, our one person, she had gone to the four-year school, and even just working with her, I'm like, I know you don't need this for your current role, but it would really make sense for you to go ahead and sit for the exam. And she did. So she, you know, like and she was, I think it was, you know, maybe it's very um, like I said, when you go take these exams, it's very um serious. And, you know, and no one wants to fail, right? So I think sometimes there's just a lot of apprehension. Um, but if you just go in there and do it, and if you don't pass the first time, you can always take it again. You know, just study. So I would say get a credential, get a mentor, you know, really find out what you want to do because there's a lot to do in our profession. So really just reaching out and, you know, talking to people that do different things, um, or even in the you know, traditional world. H IM is needed there still as well.

SPEAKER_00 23:05

Oh, it's amazing. I appreciate it. That's uh a great way to put the human touch onto it. So I uh really appreciate both your time and your thoughts. And we really appreciate you joining us on the podcast. Thank you, Jennifer.

Closing Thoughts And Contact

SPEAKER_02 23:17

You are welcome, and thank you for having me. I have really enjoyed um and going back to my early career days.

SPEAKER_00 23:22

At Acuity, we're transforming healthcare reimbursement with a provider-driven, innovative approach. We share valuable clinical and coding insights and current best practices to improve financial outcomes across health systems. If you have any questions or would like to offer a topic to discuss, please email info at acuityhealthcare.com. Opinions expressed in this production are those of the host or guest and do not represent official stances of acuity. The suggestions, advice, and guidance provided by the individuals featured in this podcast are not intended to replace any medical advice, consultation, or treatment you may receive from your healthcare provider.