While understanding medical billing and coding is something members of our physician Facebook groups often express frustration with even after years of clinical work, its complexity and importance to insurance reimbursement make for a niche non-clinical opportunity for doctors. If you didn’t mind the administrative tasks that accompany being an attending physician but want to transition away from direct patient care and the multitude of other responsibilities inherent to the job, becoming a clinical documentation improvement (CDI) specialist may be worth looking into. Learn about the role of the CDI specialist: what the role entails, which physicians might be a good fit, what the position pays, and more.
Quick Links
What does a clinical documentation improvement (CDI) specialist physician do?
Clinical documentation improvement (CDI) specialists typically work for companies that contract their services out to multiple hospital systems, directly for large hospital and healthcare systems, or even a large private practice. These specialists could be physicians, nurses, or other members of the healthcare team depending on the company. As the use of AI increases, there are also employers that are health tech companies/software companies whose software products enhance clinical documentation or work in revenue cycle management.
A job as a CDI specialist is essentially chart review work that ensures the completeness and accuracy of how medical care is documented. As most of us physicians weren’t formally taught how to bill and code during our training, we may not realize how our documentation has a downstream impact on how effective billing is and what can lead to denials even if we have done all the appropriate work. For example, for certain codes, you may have to have documented certain things or said things in a particular way to justify billing for that code. Alternatively, you may have grounds to bill for more codes, but just not know it.
A CDI specialist will actually go through the existing documentation from patient encounters and review the information for each individual patient to understand the overall clinical picture and what services were provided, and then figure out the most appropriate and optimized billing. In some cases, this may result in increased reimbursement, while in others, it will actually lead to downcoding of what a clinician initially specified, but keep the hospital safe from fraud or unnecessary audits.
This becomes especially important for things such as choosing how to appropriately bill for the level of care provided, or procedural fields where there are strict criteria for how things are coded and how many codes are associated with a particular procedure and in what situations. While some clinicians may add some subjectivity to their assessment, it’s the CDI specialist’s job to ensure that the codes ultimately billed for are based on objective criteria that can be justified if questioned. Additionally, they may review the operative or procedural notes and realize that something additional was performed that the surgeon performing the procedure could be billed separately, and in this case they’ll be the one increasing the codes that are submitted.
Therefore, the clinical documentation improvement specialist allows hospitals and other organizations or practices to optimize their revenue cycle management and reimbursement processes, as well as ensures that they maximize the revenue they’re entitled to based on the services administered.
There are also advanced roles available, such as the Physician Medical Director of the CDI team, which may oversee the team. You can also consider starting a side gig helping smaller private practices and organizations without a dedicated CDI specialist as a consultant to help improve their billing and coding.
What does a typical day as a CDI specialist look like?
While this work could be in person, increasingly, remote options are becoming commonplace.
For the most part, this is going to be a regular business hours sort of job, without nights, weekends, or holidays. Some companies will require an occasional weekend shift, though, so make sure you ask before assuming.
Depending on how large the organization is, a CDI specialist may work directly with the coder(s) or with a team of other CDI specialists. As you get more used to the work, you may get assigned to work with a particular person that is a good fit for both of you, with the physician doing the clinical side, and the coder focusing on the coding side. You’ll go through the charts and look for opportunities, inconsistencies, and accuracy. If you have questions, there is usually a team in place to run things by. Depending on the company, you may also be responsible for contacting a clinician about anything that is unclear or incomplete, and asking them to correct it prior to submitting the claim. Other companies will have another process to deliver this feedback to the clinician.
Who is the CDI specialist role a good fit for?
Outside of cash-only practices such as the Direct Primary Care (DPC) model, physicians aren’t strangers to coding (everyone wants to get paid for their work). However, in order to be good at your job as a CDI specialist, you have to care to dive deeper into the world of billing and coding and revenue cycle management. This is something many physicians really don’t enjoy, and would rather not deal with.
If, however, you enjoy learning these processes and systems inside and out or have always been fascinated by the economics of the healthcare system, this role may be a great fit for you. An added perk is that while you may not be practicing clinically anymore, you’ll get to stay more in touch with patient care cases through your chart review than you might with other non-clinical roles. Since you’re literally reading the charts day to day, you may see the cases as opportunities to learn and/or continue to enjoy the expertise you built in medical school.
Physicians that are a good fit:
Want to transition to a more traditional work schedule similar to a standard 9-5 (though confirm the actual shift hours before accepting a position)
Want a routine less stressful “day job” while having flexibility outside of shifts to continue to work clinically part-time, such as locums
Want the ability to work from home
Enjoy chart review and being a part of systems improvement
Are detail oriented and analytical thinkers
Consider a different non-clinical career if:
You don’t enjoy sitting in front of a computer all day
You prefer more in-person interactions
You hate billing and coding (obviously)
You are a specialist and need to maintain a salary similar to your clinical work
What does being a CDI specialist pay?
As with most things, these salaries are supply and demand based. Since a MD or DO degree is not required for all of these positions and other professionals such as nurses also hold these roles, the salary tends to be significantly less than other non-clinical jobs for physicians. For very non-specialized positions it can be as low as $71,500 to $110,000, with an average salary of $83,000. That said, depending on your specialty or if you have more of a supervisory role on the team, you will likely get a higher salary. For example, procedural specialists would understand procedure notes better than non-physicians, and we’ve some surgeons making $200,000 to $350,000. Speak with other physicians working in this role to get an idea of their pay, as it will give you a better idea than searching online, which typically will include non-physicians in their average reported salaries.
Though this may not be financially feasible for some physicians, it can be a great opportunity for physicians who need a change, are desiring remote work or more routine work hours, non clinical opportunity for retiring physicians looking to stay involved in medicine with a low-stress job.
How do I get a CDI specialist job, and are there any special requirements?
Physicians hired for this role usually need to be licensed and board certified. Many companies actually will help physicians maintain these requirements by providing a stipend to keep their license and CME current.
For work experience, most companies will want real world experience within the specialty. You can expect that they will require some years of experience after residency. We have seen up to 5 years after residency.
A wide range of subspecialties are considered and needed for these positions, which will attract the non-primary care physicians.
Specific billing and coding training isn’t usually a requirement as most companies provide pretty comprehensive training on the guidelines they use and may even require that you shadow other physicians doing it at the beginning. In theory, it could give you an advantage over other candidates to get a certification, but we haven’t found that most physicians need this secondary to how in demand they currently are for these positions. The American Health Information Management Association (AHIMA), the American College of Physician Advisors, and the Association of Clinical Documentation Integrity Specialists (ACDIS) all have some certifications.
If you currently work within a hospital system, you may have the opportunity to network with others who work in the role or work closely with CDI specialists. Use your connections at the hospital to see if you can reach out to:
CDI specialists who work for them
Physician advisors who may be able to help point you in the right direction or mentor you
Billers or coders within your organization (or with another large group you’re familiar with)
See if you can volunteer to help them or shadow them to become more familiar with the specifics of coding.
You will want to make sure that you create an appropriate resume for nonclinical work to help your resume stick out among the other candidates when applying online through job boards for remote positions.
Conclusion
While a job as a CDI specialist may not provide the same level of income as a clinical job, physicians who have made the transition to this role say the opportunity cost of trading a higher income for less stress and responsibility – and more time home with family – have been worth it for them. If you have an analytical mind and enjoy digging deep into the process of medical billing and coding, this could be a great second career for the right phase of your career and life.
If becoming a CDI specialist doesn’t sound like the next right step for you or you need to bridge the experience gap before transitioning, check out several other options available.
Learn more
Dive deeper into non-clinical physician jobs in our blog
Understanding medical billing and coding primer for physicians