Rich Simon has been an esteemed leader in the field of revenue cycle management for over 2 decades. Now a Senior Partner at CodersDirect.com, Rich is currently specializing in the coding aspect of the medical billing domain.

In this in-depth interview, Rich recounts his early days in the field and the evolution of the domain since then. He also shares the core philosophies that have brought him recognition from his peers and the trust of his clients.

Starting out in Medical Billing

Rich began his journey working with medical laboratories in medical billing in the 1980s. In 1996, he began working with hospitals and was responsible for various aspects from charged reviews to managed care reviews. The firm, at the time, was also active in coding which was where Rich first interacted with this aspect.

Having spent over two decades in the field, Rich took up retirement before he started his present company, CodersDirect.com. This company is a digital platform for coders in the medical billing industry along with nurses and physicians. This allows for an accurate and holistic revenue cycle audit of all claims.

Recalling his first account, Rich remembers it being a hospital in Connecticut. At the time, they were in a remote area and needed a coder to work onsite. Rich and his team took up the challenge and were able to offer significant value through their database of coders.

Following that they have worked for several government contractors for the VA. According to Rich, there are 150 VAs nationwide and the coding process is different from the general industry.  Finding these specialized coders led to a flat fee per placement which helped bring in the revenue as well.

Changes in RCM and Coding in the past 2 decades

The biggest change has been the shift from onsite to remote. Initially, everything was done manually. While working on managed care reviews, Rich recounts going to the hospital and physically checking the invoices to make sure that the hospital was being reimbursed for certain implants. These days everything is done remotely, there is no need to actually visit the hospital.

Another big change is in the development of software. When Rich started out in the field about 25 years ago, there was no software. In the past few years, there have been numerous platforms developed to aid coders in processing claims.

‘When we used to do sales calls, we had to go in person and with the CFO and the controller, it’s not done that way anymore. These days you’re bidding on contracts working for hospitals you have never visited.’

Current Business Scope

At present, CodersDirect.com acts as a middleman for connecting companies and coders. The firm receives a referral fee for every successful connection. The firm does not have any employees but an exhaustive database that helps them connect the right coder with the right organization.

For Rich, coding has always been at the core of his work experience. Even during his tenure in California in 1996, his prime areas of responsibility were coding and managed care reviews. Medical billing has never been a focus for Rich and when required he has referred the work to companies but never felt the need to personally enter that domain.

US-based certified coders and nurses looking to tie up with Rich’s website can do so easily. All they have to do is fill out the information required on the website. Rich has connections with CPCA, AHIMA, and AAPC as well. Once they connect the coder or applicant with the employer, the final due diligence is the responsibility of the employer.

Rich has also managed to create a private system for contacting employees that allow them to retain their anonymity online. For instance, the names of the coders are not provided on the website but a referral number. Employers can use the email to contact the candidate and request a resume through the private system. This allows employees the freedom to decide if they would want to work with a particular employer or not without impacting their current relationships in the industry.

‘We did not want anybody coming in and sending a 1000 e-mails out at a time.  So we restricted that to 100 a month for a small fee. This helped ensure honesty in the workspace.’

Currently, Rich’s clientele includes large consultants. These include massive organizations such as Oregon Science and hospitals. Their database houses over 1000 recruiters that can cater to all their clients. With Rich looking to retire soon, they prefer to cap the number of clients and recruiters to a manageable amount rather than focus on scaling up and expanding.

Standout moments in the Coding journey

For Rich, the biggest standout moment is maintaining consistency in operations even with the massive shift from manual to online. This was a huge shift for the industry as a whole and it speaks highly of the quality of service provided that they can continue with the same format as before.

Additionally, it is a huge source of pride for Rich to be able to create a niche for himself in the revenue cycle domain with coding. He is no longer involved in audits or the revenue cycle as a whole. Instead, they have cultivated a specific niche for themselves as the middleman connecting employers with coders.

Encountering and Overcoming Significant Challenges

Initially, the biggest challenge was getting recognized in the industry. Now Rich has over 30,000 connections on LinkedIn which has brought him valuable recognition and clients for his platform.

‘It’s always nice to have some more clients that you can give referrals to but the flow is where we want to point in time.  So the challenges, we got the website to where it needs to be.  We got the people in there that need to be in there.  We got the recruiters in there and we’re well known in the industry and so we had some challenges but we met those challenges and we’re fine now.’

Future Plans for the Business

Rich has been able to build and expand his entire business on LinkedIn. He made great connections on this business platform and expanded from there into the AAPC, AHIMA, and CDI groups. The team also did some advertising for the AAPC local state chapter conventions that helped enhance their brand recognition but credits LinkedIn for 90% of the success. The team uses LinkedIn predominantly to post jobs. This helps a lot of recruiters locate them and fill in their details on the website.

Regarding future expansion, Rich has no plans to grow the business further as he is planning to retire within the year. However, with the framework well in place, whoever purchases the website will be able to aggressively grow and expand the business to new heights.

Top philosophies and core values

Talking about core values, honesty is at the top of the list for Rich. The team works very hard to gain people’s trust and work with honesty and integrity in all they do.

‘We don’t do anything behind the boards. I think honesty is the best policy all around in life and in business.  That’s the most important core of any operation and that’s why a lot of people utilize our services.’

Another business philosophy that Rich stands by is to price everything fairly. This is important in building long-term relationships and gaining trust. Finally, it also important to focus on the quality of work being done.

‘There are people I established a relationship with for 10-15 years and I trust their integrity and their ability. They don’t need me supervising them on what needs to be done.  It is important to have the right person doing the work.’

Advice for People Entering the Coding Industry

Having spent over two decades in this field, Rich has seen several changes. Talking honestly, he reveals that he is hesitant to encourage people to get into coding as the job market has changed significantly and is continuing to change. Jobs are difficult to come by for new coders and anticipates a certain amount of job instability in the coming years.

However, for those that have decided on coding, Rich recommends getting certified under AHIMA over the AAPC and consider getting certified in a specialty. Additionally, he recommends new coders looking to break into the market consider VAs, DoDs and insurance carriers. Larger corporations and consultants tend to rely on coders with experience.

‘CDI is hot right now but requires coders with extensive experience and requires a lot more sophisticated type of background than just having a certification.’

 Key Benefits of CodersDirect.com Services to Customers

Free access to an exhaustive database of coders and nurses – this is the biggest benefit offered by the website. Rich recounts in the early days when he had to spend USD 200-300 for every ad when they needed to hire a coder or nurse. This lead to huge expenses that didn’t necessarily guarantee quality personnel.

By making the database access free, Rich is able to help people save a lot of money while also targeting certified coders and nurses to work on their projects. The companies are only required to pay a fee once they finalize a hire.

Vision for the Coding Industry

Rich believes that the entire revenue cycle management domain is in for significant changes, one aspect of which will be coding. With the evolution of software and AI, the coding function will be fast changing. There will still be a need for specialty coding but basic IP and OP coding will be replaced by software, especially in larger facilities looking for cost savings.

‘I wish I could be more optimistic but I think that opportunities for basic coders will start to tighten up in the next few years.  Specialization is going to be the key for survival’

Staying Successful in the Coding Domain

For those already operating in this domain, Rich believes to remain successful, it is crucial to maintain integrity in work and build relationships with clients. Earlier, when hospitals required managed care reviews, they would have to search for and reach out to coders. However, now with things changing and the competition increasing significantly, it can be difficult to break out into the coding world. At this time, working hard at the jobs you get and doing quality work can help you build relationships and get referrals.

Another important point to keep in mind is not to take anything for granted. Every job, every business, it is important to give 150% of your effort and do a good job to avoid losing out to the competition.

‘I heard that owing to automation, 50% of jobs are going to go away in the next 10 years. Coding is prime for software.  It’s such a manual process if you think about it.’

Follow Rich Simon On : LinkedIn