Clinical Document Specialist, is it right for me?

Posted
by Bunnybop Bunnybop, ASN Member

Specializes in Medical Surgical.

Hello all,

I was looking for some input about being clinical document specialist. Nursing is my second career. I spent 15 years doing accounts receivable and a bit of human resources (Workers Compensation & Disability) for a medium sized company. I have been a Med/Surgical Nurse at a Hospital in Downtown Baltimore for 3 years. I am looking to find a job that combines my past and present experience together.

Can you offer any advice on things I should study for applying for this position? I know it involves using your nursing knowledge to review charts and request clarification, so the hospital can be reimbursed correctly. Is there software you use to help generate query's? A reference book that shows what relevant services a doctor should have ordered for a certain diagnosis? Hot topics you need to be master of? I've only found a handful of threats on CDS and some of what I read make it sound like you need to be an ICU nurse with 20 years exp. And others seem to have no experience at all.

Becoming a nurse has made me realize that I need to be in total control of my surroundings. I personally need to do an excellent job & be a master at my job, bedside nursing is to chaotic with so many unknown variables I feel like a wreck every day I come home. I was a resource to my co-workers in my previous job and I loved it and I hope to find a new position in nursing where I can be a Master and resource to others again.

Any advice would be most welcome!

delphine22

delphine22

Specializes in Quality, Cardiac Stepdown, MICU. Has 5 years experience. 306 Posts

I can tell you that the majority of our CDI queries at this time (I do not do this job but just sat and talked with them yesterday) are related to sepsis, because it's difficult for the physicians to master and a high-value code that often gets missed.

I work for a large healthcare corporation and they send our CDI folks a list of charts that must be queried daily, with detailed criteria, pre-worded queries, etc. But they are also told to use their nursing judgment, so you get to do that. It's exactly 50% being glued to a computer screen and 50% chasing doctors to provide education.

jjandia4

jjandia4

4 Posts

I would love some information, too. I am in the final stage of an interview for this position and am not sure if it's for me. I have over 9 years RN experience, the first 8 were in ED, the last have been in a smaller private clinic - which I have loved! But I have to move and I don't think I will get the same job anywhere else as I have here, especially with the pay I am receiving here. I am considering trying this career, but would love to know more about the salary.

The position I am applying for is a salaried position vs. hourly - for those of you who do this work do you find the pay comparable to floor nurses? Higher? Lower?

I am considering this job because the people who do it seem passionate about what they do, they seem to love it, and I am always up for trying something new, but I would want to be paid at least the same as a floor nurse (obviously preferably more since it is a specialty)...and I'm hoping that the amount of flexibility and remote work will be high.

What do you love most about this work? And what do you hate? I am a people person and I'm worried I won't have enough interaction with people...

ivyleaf

ivyleaf

Specializes in Ambulatory Case Management, Clinic, Psychiatry. Has 15 years experience. 366 Posts

dId either of you end up working in CDI? Would love to know more! 

Bunnybop

Bunnybop, ASN

Specializes in Medical Surgical. 22 Posts

3 hours ago, ivyleaf said:

dId either of you end up working in CDI? Would love to know more! 

I

I have been doing this job a little over a year and I do prefer it over bedside nursing. However, it is not exactly what I was expecting. I think my situation might be different compared to other facilities with an established CDI department.  I also work in Maryland and we use APR-DRG vs MS-DRG and we work on MHACS (Maryland Hospital Acquired Conditions). There is not a lot of training/information I can find for APR-DRG which has been challenging. I originally started out making more then I did as a floor nurse, but my hospital gave all the nurses a pay increase and I now make less then I would if I were still on the floor.

My day consists of reviewing a minimum of 25 charts a day (12 new reviews and 13 follow ups) and sending out approx 5 queries a day or more if possible. We also write all the Coder queries and try to look for ways to eliminate MHAC’s by researching the chart to determine if a condition was present on admission, or if we sequence a code in a certain order it will eliminate it. We use 3M 360 software and Meditech to do our chart reviews. My department consists of my Manager, 2 other CDI RN’s and one part time employee who tracks down the doctors to sign their queries (she is a godsend)! Our coding department is outsourced and we are not allowed to communicate directly with them, everything has to go through my manager.

Before COVID hit I was working in the hospital. Even though we had our own office, we were required to go to our 2 units each day and spend half a day on each of them. I believe my boss’ goal was for us to have some face time with the doctors. I found it to be challenging because we would have to pack/unpack our lap top 6x a day. Fight for a spot to sit in and it can be distracting with all the noise/distractions. It would be freezing and I would have to wear my jacket and lap blanket on one of the floors. You have to pack up your stuff or pee like your butt was on fire so no one steals your stuff or your chair. I found the doctors either avoided me like the plague, or when I did have a doctor to chat with, I did not have anything I needed to speak to that Dr about specifically. Most of the doctors I speak to would rather an e-mail/text because they are so busy. Some hospitals do weekly/monthly teaching to the whole departments (Surgery/Medicine/Hospitalist/Residents). My facility has yet to embrace that (and I am a little thankful because I think I would be terrible at it :P ) Some facilities are working totally remote. Some are in the hospital still and some do a hybrid.

Now that I am working from home, my boss has increased my chart review from 18 to 25. I find I am working 10-12-hour days 5 days a week on salary pay (no overtime). While I really do enjoy working from home, I do find it challenging to stay on task some days with the distractions at home (getting my niece to stay in her on line class, the cats jumping all over my keyboard… the internet..). Or I get exhausted from just sitting and reading with no one to speak to (I know I need to make up my mind)!

Moving from the floor to CDI I am still not in control of my surroundings or my day. Even though I know I must do 25 charts a day, many things happen that mess up my workflow. My boss will ask a question about chart that I must review and its back and forth with e-mails while I try to work on the remainder of charts. Instead of giving me just 12 new charts to review a day sometimes she will give me 20! (which can be very time consuming). I will almost be done my new reviews and she throws 6 more in there and it just gets you down because you thought you might finish on time and now you won't. We are supposed to have autonomy but, my boss micro-manages us.  I must educate myself and usually on my own time and at my own expense $$.

I was never given a formal training. I sat with the Manager for one day to learn 3M and how to write a query. I sat in the office for 3 weeks attempting to code charts and was able to ask questions but was never taught how to do a chart review. My work was never reviewed so I never even knew if I was doing things right/wrong. I was only allowed to sit with one experienced CDI RN for one day and I learned so much. My boss has tried to keep us CDI’s separated from each other because we were cutting into each other’s productivity with questions, but I feel like if we were allowed to sit with each other in our own space it wouldn’t take so long to answer a question, and I could have physical resources at my fingertips (coding books and books I can’t lug around to the floor etc). I still call the experienced CDI with questions every day. I started to keep a Microsoft OneNote notebook with information in it so I can stop harassing her.

Now with that being said, I do not think my experience is the normal. One of the CDI RN’s I work with has been doing this for 20 years, mostly MS-DRG and she said she has never worked at place like mine. She said it’s easy to review 25+ charts a day at other places and a lot of fun. I interviewed at two other CDI facilities. The first was a hospital with the same number of beds as we have, and they have 5 CDI RN’s and their manager. They work in a small office and only go onto the floor to find a doctor if they have a question or need to educate the MD. They seemed so happy and laughing and it was a cohesive environment it seemed. The 2nd facility was an exceptionally large hospital organization and they had 28 CDI RN (or something like that). They have an onsite educator who was a coder and a formal training as well as a manager. They did have a high chart review rate, but they are such a well-oiled machine I think they would have trained you the right way to look for what you need quickly so you could move onto the next chart. They also were laughing and having a great time while working. I think this could be a fantastic job. I just know that not every CDI department is the same.I am hoping to hone my skills and eventually apply at another hospital where I will have a better work/life balance in the future.

Wow this was a little essay. I think I needed to vent :)