Why Competency Assessment Matters
Competency assessment ensures that HIM staff possess the knowledge and skills necessary to perform their job responsibilities accurately and safely. Many accrediting bodies, including The Joint Commission, require documented evidence of ongoing staff competency, making this a testable Leadership domain topic tied closely to organizational compliance.
Types of Competency Assessment
- Initial competency assessment: evaluates a new employee's readiness to perform job duties independently at the conclusion of orientation and training
- Ongoing or annual competency assessment: periodically reevaluates existing staff to confirm continued proficiency, particularly for high-risk or infrequently performed tasks
- Competency assessment following a process change: verifies staff proficiency after a significant system, policy, or workflow change, such as an EHR upgrade or new coding guideline
Methods of Assessment
Common competency assessment methods include direct observation of job performance, review of work product quality such as coding accuracy audit results, written or computer-based testing of job knowledge, and case study or scenario-based evaluation requiring staff to apply judgment to realistic situations. Using multiple methods in combination generally provides a more complete and defensible picture of competency than relying on a single approach.
Coding Competency Specifically
Coding competency assessment often includes double-blind coding audits, where a sample of charts is independently recoded by a second qualified coder and compared against the original coder's results, generating an objective accuracy rate. Organizations typically define a minimum acceptable accuracy threshold, commonly around 95 percent, with performance below that threshold triggering targeted education and reassessment.
Documentation and Follow-Up
Competency assessment results must be documented in the employee's personnel file and retained according to organizational policy, since surveyors and auditors frequently request evidence of competency verification during accreditation or compliance reviews. When an assessment reveals a gap, a documented remediation plan with a defined reassessment timeline should follow.
Linking Competency to Performance Improvement
Aggregate competency data across a department can reveal systemic training gaps, informing broader in-service education priorities rather than addressing issues only at the individual employee level.
Exam Tips
Expect questions on when competency reassessment is triggered, such as after a process change, and questions on double-blind coding audit methodology and typical accuracy thresholds.
Key takeaway: Documented, multi-method competency assessment supports both regulatory compliance and workforce quality, an essential Leadership domain skill for HIM managers.