Q&A: CDI applicants with a coding background

Q: I am exploring the idea of staffing our outpatient CDI program using both candidates with an RN and an HIM/coding background. We currently have all RNs on our CDI team who have also gotten (at the least) their certified professional coder (CPC) credential. If we decide to include coders to review charts and collaborate with my current RNs regarding queries, I’d think the requirements would be that the candidate holds the CPC and certified risk adjustment coder (CRC) credentials, and has enough coding experience to have decent clinical knowledge. What other requirements would you suggest?

A: For a Level I coding position, two years of professional medical group coding experience at minimum is a good starting point. Listing requirements and certifications for this kind of applicant could look something like the following:

Required experience:

• ICD-10-CM coding principles and procedures
• HCPCS, CPT and modifier coding
• At least two years of professional medical group coding

Preferred experience:

• HCC coding and risk adjustment assignment as it relates to provider documentation
• Proficient experience with Epic and/or other major EHR vendor software
• Presenting education to coders, providers and/or other caregivers
• Clinical experience a plus

Certification/licenses:

• CPC certification or Certified Coding Specialist-Physician based (CCS-P)
• A minimum of one additional advanced certification, required within one year of hire
• CRC certification

Or, if you’re wanting more experience, a Level II coding position requirements could look something like this:

Required experience:

• Five years of professional medical group coding experience
• Three years of working in risk adjustment coding, provider queries, and HCC provider chart reviews
• Experience in ICD-10-CM coding, guidelines, principles, and procedures
• HCPCS, CPT, CPT II, and modifier coding
• CMS HCC, HHS HCC, Rx HCC coding, and risk adjustment assignment as it relates to provider documentation
• Proficient experience with Epic and/or other major EHR vendor software
• Presenting education to coders, providers, and/or other healthcare givers
• Strong communication and interpersonal skills presenting education
• AHA Coding Clinic and authoritative coding resources
• Knowledge of Microsoft Office (Outlook, PowerPoint, Excel)

Preferred experience

• Clinical experience a plus

Required certification/licenses

• CPC or CCS-P certification
• CRC certification

Preferred certification/licenses

• Certified Clinical Documentation Specialist-Outpatient (CCDS-O) certification
• Certified Documentation Expert Outpatient (CDEO) certification
• Clinical Documentation Improvement Professional (CDIP) certification

ACDIS members also have access to sample job descriptions that can be altered and adapted to fit a program’s needs. You can browse all of the current samples by going to “Job Descriptions” under the menu bar of the main “Resources” tab or clicking here.

Editor’s Note: This question was answered by members of the ACDIS CDI Leadership Council.