7.3 Human Resources and Staffing

Job Descriptions, Recruitment, and Onboarding

Human-resource management begins with the job description — a document listing a position's title, duties, required qualifications, competencies, physical demands, and reporting relationship. It is the foundation for recruiting, interviewing, setting pay grades, appraising performance, and complying with the Americans with Disabilities Act (ADA) (which protects only the essential functions of a job).

Recruitment is sourcing and selecting candidates: posting the position, screening résumés, structured interviewing (asking all candidates the same job-related questions to avoid bias), checking references, and verifying credentials. Onboarding (orientation) brings the new hire into the organization — completing I-9 and tax forms, HIPAA and compliance training, and department-specific competency validation.

A structured, behavior-based interview is both more predictive and more legally defensible than an unstructured chat. Interview questions must stay job-related: asking about age, religion, national origin, disability, marital or family status, or arrest history can violate equal-employment law, so trained interviewers avoid them.

The job description should be paired with a job specification (the minimum knowledge, skills, and abilities) and a performance standard (the measurable level of acceptable output). Together these three documents form the backbone of a defensible, consistent HR process, from posting through annual review. Many HIM positions also list the required credential — RHIT, RHIA, or a coding credential such as CCS — as a bona fide occupational qualification.

Productivity Standards and FTE Staffing Math

HIM managers staff departments using productivity standards and full-time equivalents (FTEs).

One FTE = 2,080 paid hours/year (40 hours/week × 52 weeks). A position can be filled by one full-timer or several part-timers totaling 2,080 hours. Productive FTEs exclude paid-but-not-worked time (PTO, holidays, sick), so a manager must staff above the bare productive need.

Worked example — how many FTEs to code the inpatient workload?

• Total hours needed = 30,000 ÷ 3 = 10,000 hours
• FTEs required = 10,000 ÷ 1,800 = 5.6 FTEs

Productivity standards also gauge release-of-information (requests/hour), transcription (lines/hour), and file/retrieval rates. Use them to set staffing, justify hires, and evaluate individual performance.

Appraisals, Training, and Discipline

The performance appraisal measures an employee's results against the standards in the job description over a review period. Effective appraisals are based on objective, documented data (e.g., coding accuracy and productivity), avoid recency bias and the halo effect (one trait coloring all ratings), and feed development goals.

Training and development are ongoing — competency assessment at hire, in-service education on coding-guideline updates (ICD-10-CM/PCS code changes each October 1), and cross-training for coverage.

Progressive (corrective) discipline escalates consistently and is documented at every step:

1. Verbal warning (counseling)
2. Written warning
3. Suspension or final warning
4. Termination

Key Employment Laws

Remember FMLA's 12-week entitlement and that FLSA governs overtime eligibility (exempt vs. non-exempt).

Scheduling, Retention, and the Workforce

Beyond raw FTE math, HIM managers build work schedules that cover service hours while controlling cost. Productive vs. nonproductive time must be planned: productive time is hours actually worked, while nonproductive (paid) time includes PTO, holidays, education, and orientation. A budget that ignores nonproductive time will be chronically understaffed. Remote and hybrid coding is now standard; managers monitor remote productivity through encoder logs and audit samples rather than physical presence.

Retention is cheaper than recruitment — replacing a credentialed coder can cost a large fraction of an annual salary in lost productivity and training. Managers improve retention through career ladders, competitive pay, recognition (a Herzberg motivator), flexible scheduling, and meaningful work. Succession planning identifies and develops internal candidates for key roles before vacancies occur, and cross-training ensures coverage when a coder or ROI specialist is absent. Managers also track turnover and vacancy rates as workforce metrics, because a rising turnover rate is an early warning of low engagement or below-market pay.

A simple turnover rate is the number of separations in a period divided by the average number of employees, expressed as a percentage.

Teams and Conflict Management

Much HIM improvement work happens in teams. Tuckman's model describes team development as forming, storming, norming, performing, and adjourning — the storming stage, where conflict surfaces, is normal and not a sign of failure. Managers handle conflict through styles such as collaborating (win-win, best for important issues), compromising, accommodating, competing, and avoiding. Diversity, equity, and inclusion and cultural competence are workforce expectations, and harassment-free workplace policies are both a legal (Title VII) and ethical obligation.

Effective supervisors give timely, specific, behavior-based feedback and document performance contemporaneously rather than relying on memory at appraisal time. When a team stalls, the leader returns to the basics — clarifying goals, roles, and ground rules — rather than abandoning the team, because productive performance follows naturally once the storming and norming stages are worked through.