Health Information Management

Associate Director’s Note: Getting your foot in the CDI door

CDI Strategies, March 19, 2015

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Sure, CDI practices might lead a hospital to the proverbial pot o’ gold hidden in the medical record, but in the early days of the profession, finding someone with the experience necessary to perform the role was akin to capturing a leprechaun.

While there are a host of experienced CDI professionals these days (ACDIS membership tops 4,000 and readership of this eNewsletter exceeds 20,000) those with multiple years’ experience are in high demand and often expect to earn top dollar. Those willing to travel or move to a different location may be able to earn even more than that.

Flipping the holiday mythology on its head, over on the other side of the forest we’ve got leprechauns aplenty with their cauldrons’ full of various talents wandering around looking for a way to disseminate them. At least twice a week, we (at ACDIS national) are approached by someone interested in joining the CDI ranks but befuddled as to how to proceed—their career aspirations seemingly somewhere on the other side of the rainbow.

What to do? The need for CDI staff only continues to grow, while facilities face ever tighter purse strings.

For many, the answer remains the same as it was in those early days: examine a candidate’s professional background and provide training for staff who fit best.

Hospitals often post an open CDI position and interview candidates from within their own nursing, coding, or other professional ranks. The essential skills needed for the job include:

  • Effective communication—well-spoken, well-written, highly organized individuals
  • Subject expertise—extensive knowledge of clinical and/or coding guidelines
  • Inquisitive and analytical thinking—ability to link disparate pieces of information to identify missing diagnoses in the medical record

Once the “right” individual with the principal skills is identified, the facility invests in mentoring and training, often sending him or her to a CDI Boot Camp and providing new staff with both general and internally specific materials to foster professional growth. By most accounts, it may take three to six months before a CDI specialist becomes capable of conducting concurrent record reviews and querying physicians on their own.

Those thinking about making a career shift need to roll up their sleeves and take responsibility for some self-education, as well. Here are some suggestions:

  1. Use the ACDIS website and social media forums to learn more about the profession. The CDI Week page has a terrific video that explains CDI efforts and our YouTube channel offers some basic videos about what a DRG is.
  2. Find out if your facility has a CDI program. If so, ask to professionally shadow someone during a portion of their day in order to learn more about the role.
  3. Connect with your local ACDIS chapter. If your facility does not have a CDI program or you are unable to shadow someone there, reach out to your local chapter leadership to see if any of its members might be willing to let you visit for an hour or two to see how the role is performed at their facility. Attend chapter meetings to become better informed about the position and various demands, frustrations, and benefits of the role.
  4. Review openings on the ACDIS job postings page. If you’re still interested in pursuing the role after you’ve completed this level of research perhaps it’s time to start applying for openings in your area to find that right fit, that right facility willing to invest as much in your future as you hope to invest in theirs.
  5. Join ACDIS. The website has a number of open resources, but also a large number of member-only benefits that can help you on your career such as the CDI Talk networking group, the CDI Journal, surveys and white papers, and the Forms & Tools Library.
  6. Considering making a financial investment in your future career. If this is the career you really want, purchase and review some of the books and materials available. In particular, the new-to-CDI individual would want to review The Clinical Documentation Improvement Specialist’s Complete Training Guideand The 2015 CDI Pocket Guide. There are also online learning libraries available which walk you through the CDI process and specific oft-queried clinical concerns.
  7. Seek the Certified Clinical Documentation Specialist (CCDS) certification when you have the minimum two years of experience as a concurrent clinical documentation specialist. The ACDIS website has a section devoted to certification and clearly defines the educational and experience requirements for eligibility. Start exploring your qualifications by downloading and reading the Exam Candidate’s Handbook.

No one becomes an expert overnight. As we endeavor to expand our CDI ranks, we must support those looking for help.

Here are some additional articles regarding how facilities have established mentoring programs that should provide you with a little extra advice:

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