Guest Post: How to make a CDS

by Lynne Spryszak, RN, CCDS, CPC

While those of us at ACDIS are already working as CDIS there are nurses and coders out there who e-mail me and ask how to become a CDIS so I thought I’d write about what I look for when I’m hiring someone. FYI, folks, opinions ahead.

There are more job openings for CDIS right now than there are people who have experience doing the job. In my estimation, this is both good and bad. Good, because it means there are opportunities out there, and bad because it’s harder to find the right people to fill those open positions.

It was only last year when I had an open position to fill that I had not one, but two experienced applicants. Prior to this point I was pretty much resigned to having to train any new employee from the ground up. This is an expensive proposition since I’ve found that it takes AT LEAST a full year before this new hire becomes a productive member of the team. 

First, there’s weeks of didactic learning followed by one-on-one mentoring, then months of a reduced assignment before graduating to a full assignment with the required ancillary responsibilities (developing query forms, reports, education, etc.). In addition, the team’s productivity is decreased because they’re training the new employee and usually unable to complete all their reviews. 

So, the productivity and results of the team suffer for months before things get back to baseline. Lost revenue is hard to make up. While this is the reality of the situation, Administration doesn’t want to hear excuses, they want to see steady results. Hospitals starting a new program have different challenges: everyone is new, they all learn together, productivity is poor before it starts paying results, but at least the consultants/trainers are in charge of the education and expectations are somewhat muted. It’s understood that things will take time. 

When I started, there were 2.5 FTEs hired. The .5 member quit in the second week of training leaving just two of us to get the program off the ground, show results (successful ones) and keep the program viable. 

What a challenge: both of us were new to the institution, knew no one, and more importantly, were ignorant of the politics and culture. We had just completed our training, the consultants had gone, and suddenly WE had to train the new part-time CDIS. Talk about the blind leading the blind! Looking back, it was probably fear of losing our jobs and stubbornness that made it work. But it was great learning experience.

So, what do I look for when interviewing someone for a CDIS position? Everything but coding knowledge, actually. I look for someone who has a track record of being a quick learner. Someone who has excellent written and oral communication skills, well-developed computer skills (Word, Excel, internet savvy, how to use an EMR), the ability to think on their feet, someone who doesn’t ask about salary, vacation time and benefits at the first interview, and someone who really sounds excited about doing something completely different than they’ve done before. 

A word to applicants: if you can’t spell on your resume (with spell-check, for gosh sake) then I’m going to assume you won’t bring any detail to the job, either. If you bad-mouth your previous employer or co-workers, I’ll assume you’ll do the same to me. If you act like you know it all, you probably don’t.

Admitting that you still have something to learn goes a long way with me. One of my best employees came to me with experience as a NICU nurse. NICU! How does this experience relate to Medicare patients? But she was eager, wanted to learn something new and was able to communicate effectively. She is a terrific critical thinker, is goal-oriented and is a model team player. I played a hunch and was abundantly rewarded. 

But (another but), a new graduate, no matter how smart, needs to have done time in the trenches. You have to know the medications, disease process – how it’s worked up, what the symptoms are, how it’s treated, what happens next. This is where there’s no substitute for clinical experience. You have to know how and sometimes, more importantly, when to pin a physician down and how to phrase a question to get the desired response.

Here’s where the oral and written communication skills come in. Leading queries? It’s all in how you say (write) it. I can’t teach someone how to write; there’s enough to learn as it is. Fortunately, future CDIS now have resources available. People interested in becoming a CDIS can prepare. Here at HCPro we have the “Clinical Documentation Improvement Specialist’s Handbook”, and many other print and audio resources that address the needs of current or future CDIS. The AAPC also offers seminars and learning materials.

My theory is that no knowledge is ever wasted. If not for this job, then possibly the next. More is better. Job descriptions are just that: a summary of the tasks involved to perform the job and a description of the minimum educational requirements. Defining the characteristics of the perfect CDIS is more difficult. What do you look for when hiring a new CDIS?

Editor's note: Spryszak, at the time of this article's release, as an independent HIM consultant based in Roselle, IL. Her areas of expertise include clinical documentation and coding compliance, quality improvement, physician education, leadership and program development.