Darlene McKendrick, RHIA, CCS has been in the Health Information Management (HIM) field for 37 years. Most of those years have been in the health insurance and hospital setting. Since 2016, she has been a DRG Coding and Clinical Validation Analyst for Excellus Blue Cross Blue Shield (BCBS). Darlene has a strong background in medical coding and health care management. Technology advances have changed the HIM field considerably over time. Her first position in the field working for Excellus was in a completely paper record environment. She mentions “now there is so much more flexibility with access to electronic medical records (EMRs), we can log in at any point and do the reviews, and it saves us time.” Today, her responsibilities include performing inpatient DRG/Coding validation for 3 participating hospital systems.
Prior to this role, she worked for MVP Health Care for 12 years in multiple roles, continually taking on new responsibilities and growing with the company. She began as a DRG analyst in 2005. Darlene contemplates, “I found coding was my interest right out of school, and that’s where the majority of my career has been, but I have ventured off that path to explore other areas. The first time I did that was when I was at MVP – they were looking for someone to complete DRG reviews on a temporary basis, and with my husband deployed, I jumped on board. That is when my career shifted gears at MVP.” In 2009, she became supervisor of Retrospective/DRG/physician claim reviews; by 2012, she was the Care and Disease Management Quality Compliance Program Coordinator and later became Process Manager in 2016.
Darlene describes her current role, “DRG validations include MS-DRG’s and APR-DRG’s and reviews include POA, discharge dispositions and ICD-10-CM/PCS coding validations. We look at DRGs, those with CCs and major CCs, and DRGS where the principal diagnosis doesn’t match the procedure, then we go online through the EMR and audit behind the coder to validate the codes assigned. Audit outcomes are communicated to hospitals via written correspondence for initial changes, appeals, and dispute resolution. In addition to her current role, Darlene has been an active volunteer with RRHIMA and NYHIMA for many years. She has served on the Board of Directors with RRHIMA intermittently since 1996 and has been president twice. She was also a two-time NYHIMA’s Planning Committee Chair/member for the State Conference in Rochester and has served as NYHIMA’s Advocacy and Communications Director. She is now looking into volunteering for hospice. “This is near and dear to my heart. My grandmother had these services for end-of-life care, and I appreciate those that gave their time for her. It meant so much to us (the family)”.
When contemplating what initially drew her to the field, she states “I loved the idea of being in health care and not being a hands-on caregiver.” Initially Darlene was interested in nursing, but after serving as a Candy Striper at a local hospital the summer before her senior year, and witnessing a traumatic event, she began to feel differently. She contemplates, “I had already been awarded a scholarship through Keuka college for their nursing program but, I decided that nursing probably wasn’t a good fit for me”. Back at the guidance office, while looking through some of the books, she happened to see what at that time was medical record technology and thought that sounded interesting. She decided to sign up. “I am probably one of the few people that fell into this field right out of high school. And I know today, HIM is often someone’s second career. It is always enjoyable to listen to their journeys and experiences too.”
To complete her associate degree, Darlene attended SUNY Alfred for 2 years with a dual major of Medical Record Technology (MRT) and medical assisting. Darlene contemplates, “I really enjoyed my experience. We had some amazing instructors who were great role models for us. It was a small class, of about 12 graduates so we were all close.” While at Alfred, she completed a HIM summer internship at Our Lady of Victory Hospital. Darlene continued at Alfred for another semester after her MRT degree for her dual major. Her first part time job was at Bertrand Chaffee Hospital, a small 50 bed hospital, only 30 minutes from home. She was responsible for all coding, ROI, and transcription. She also did transcription for the doctor’s office next door per diem.
“My instructors and role models at Alfred were Jeanette Thomas and Michelle Green. They had such passion for the field and made learning fun and engaging. Michelle had a lot of contacts and arranged for a few of us to assist with a coding project while still in school.” This is how she discovered her passion for inpatient coding, “that’s where I got my first taste of coding, and that made me go, oh yes this is definitely what I want to do.” Darlene went on to work at Strong doing the inpatient coding, and then from there took an evening night supervisor job in the file and retrieval room. Sometime after Darlene used her connection from Alfred to get a job at Excellus, where she stayed for 6 years doing the same job she is doing now. During this time, Darlene started a family. She has two boys, Mitchell (30) and Nathan (26). “No grandbabies yet, but I do have a few fur grandkids.” Darlene considers herself a lifetime learner and is currently considering pursuing nursing to complement her HIM degree. “Not so much to become a practicing nurse but to have the RN credential, which would be helpful in my current setting of denial management.”
In articulating the differences between coding and coding validation, Darlene discusses, “there is a big difference between coding validation and clinical validation. Coders assign codes based on what is documented in the medical record. If the doctor says the patient has acute respiratory failure, the coder assigns a code for acute respiratory failure. Coding validation is an audit that ensures all the appropriate Coding guidelines and conventions are utilized. Clinical validation addresses whether a particular diagnosis is fully supported by the clinical evidence in the record.”
Darlene states “this was a huge challenge for me because coming out of school we never questioned physician documentation, and to move into this role where I am doing validation work and questioning some of the clinical information has not only been difficult but a fantastic learning experience.” In Darlene’s current role, she collaborates closely with her peers and the Medical Directors to capture both validations. It is a team approach.
She really enjoys her current role at Excellus. She shares, “what I love so much about my job is that I am constantly learning. I know back in the day, the insurance company was considered the dark side, but it is not at all like that. We follow the same guidelines and principles, and we just look at it a little differently as far as the validation goes. I really enjoy corresponding with the providers on appeals even when I find that I am wrong. Mistakes can be the best lessons learned.”
Darlene gives advice to HIM graduates and professionals, “the HIM field is very different now than it was 38 years ago. There are so many new roles and opportunities out there. Don’t be disappointed to not get that dream job right away. Spend a lot of time preparing for interviews. Most hiring managers are looking for that “good fit” for the team dynamic. It’s much easier to teach a process than to teach values. Many of our roles are remote but people skills are highly sought after. Take time during your last year of school to reach out to contacts within the HIM field and connect professionally. Several of my positions, I received through contacts within RRHIMA. Volunteer within your local, state, or national association! Push yourself out of your comfort zone from time to time. This is how we grow.”
Key behaviors that Darlene encourages include: “Optimism: it’s contagious and energetic, much better than the alternative. Diligence: Have a good work ethic and do your best regardless of what else is going on in your life; Focus: We spend 8 hours a day or more at work. I have a sign at my desk that says, “Be Here Now,” as a reminder to stay focused at work. It is impossible to multitask effectively so do one thing at a time and do it well; Patience: Give yourself grace to make mistakes and learn from them. If you have just started a new role, give it the time it deserves before you decide to move on to another position.”
Darlene keeps up with changes in the field by doing a lot of reading and attending webinars at the local, state or national level. Some of her favorites are the RRHIMA webinar series, HIAlearn (Coding with a Cuppa articles), Pinson &Tang and GeBBS Healthcare webinars. She also highly recommends listening to the ICD-10-CM Coordination and Maintenance Committee Meetings to get an understanding of why coding changes are being suggested.
A few parting words of wisdom from Darlene are to step outside of your comfort zone. Say yes to volunteering. Keep learning and growing, and lastly, cherish those acquaintances and friendships you make along the way.
Sarah Hasselstrom, RHIT
