Q&A: Career ladders and responsibilities

Q: I am wondering if any organizations would be willing to share the types of assigned work that separate roles/levels are responsible for in their department? We have had conversations pairing certifications along with validation/denial work; however, we would love to see what else is working well for others.

Response #1: One career ladder I've seen had six levels with requirement differences based primarily on years of experience. However, I felt it failed to distinguish between degree level, certification, or performance. All levels listed the same for education: RN, BSN, RHIA, RHIT, CCS, CPC, CIC, CCDS, or CDIP. Maybe it was just for retention, so it depends on what you are looking to incentivize. For instance:

• Associate CDI specialist: < One year in CDI
• CDI specialist: One year in CDI
• Senior CDI specialist: Three years in CDI and one year in nursing, coding, utilization management (UM), quality, or case management (CM)
• Auditor CDI specialist: Three years in CDI and two years in nursing, coding, UM, quality, or CM
• Lead CDI specialist: Three years in CDI and two years UM, nursing, coding, or health information management (HIM)
• CDI supervisor: Three years in CDI and two years UM, nursing, coding, or HIM with lead experience

Response #2: Our career path looks like:

• CDI I - Clinical reviewer: Entry level CDI specialist
• CDI II – Senior CDI specialist: Meets performance and productivity metrics within <10% margin of error, works as a CDI I with additional duties for staff and provider development
• CDI II - Clinical appeals specialist: Meets performance and productivity metrics with <10% margin of error, focuses on clinical validation denials and concurrent audits for vulnerabilities
• CDI III – Performance improvement lead: Meets performance and productivity metrics with ~5% margin of error or better, focuses on staff and organizational development

Response #3: I recently started the restructuring of our CDI department, which consists of 21 CDI specialists and a diversity of education/experience including RHIT, RHIA, RN, MD:

• CDI coordinator (CCDS or CDIP certified): Responsible for reports, IT tickets, query escalations, and technical support for staff
• CDI specialist I: Entry level and no certification required (CCDS or CDIP)
• CDI specialist II: Two plus years with the organization, certification of either CCDS or CDIP with the opportunity to precept a new CDI specialist
• CDI specialist III—team lead: Front line reviews as well as audit, education, and resource responsibilities
• CDI specialist III—second-level reviewer: Risk adjustment, quality, mortality, education, and resource responsibilities

Editor’s note: This question was answered by members of the ACDIS CDI Leadership Council and originally appeared in the CDI Leadership Insider, the monthly e-newsletter exclusive to Council members. For the purposes of this article, all Council member answers have been deidentified.