Note: The job is a remote job and is open to candidates in USA. Baptist Health is a not-for-profit healthcare organization providing medical care through hospitals, outpatient centers, and physician practices in South Florida. The Clinical Documentation Integrity Specialist II – DRG Validator improves the quality, completeness, and clinical accuracy of inpatient documentation and DRG assignments through concurrent validation, analytics-informed review, and technology-enabled workflows. The role also supports CDI workflow transition planning to Epic.
Responsibilities
- Responsible for improving the quality, completeness, and clinical accuracy of inpatient documentation and DRG assignment through targeted concurrent DRG validation
- The Clinical Documentation Integrity Specialist II – DRG Validator reviews selected inpatient accounts generally more than 48 hours from admission that have not been DRG optimized, using integrated electronic health record workflows, technology-enabled review worklists, and analytics-informed prioritization to focus on cases with the highest documentation, clinical validation, and reimbursement risk
- Focused review includes non-optimized DRGs, signs and symptoms DRGs, APR-DRGs with SOI/ROM of 1/1 where the clinical picture suggests higher acuity, local infection DRGs to evaluate for sepsis or systemic illness, sepsis DRGs without documented organ dysfunction or other required clinical indicators, and level-of-care versus DRG mismatch, such as ICU or step-down patients assigned minor DRGs or SOI/ROM 1/1
- Scope to include all inpatient payors
- Uses analytics informed prioritization, AI assisted worklists, and DRG encoder logic including TruBridge where implemented
- Supports Epic transition planning for CDI workflows with planned go live in July 2027
Skills
- MD/DO
- Certified Clinical Documentation Specialist (CCDS) or Certified Documentation Integrity Practitioner (CDIP)
- International medical school graduate required
- Five years of recent adult, pediatric, obstetric, inpatient medical, surgical, and critical care experience required
- Strong knowledge of Medicare MS-DRG and Medicaid APR-DRG assignment, severity of illness, risk of mortality, clinical validation, denial vulnerability, and documentation integrity required
- Experience in concurrent inpatient chart review, DRG validation, collaboration with coding professionals, and use of integrated electronic health records, web-based applications, and technology-enabled review/analytics tools required
- Knowledge of official coding guidelines, AHA Coding Clinic, CMS guidance, payer clinical validation expectations, and compliant documentation clarification consistent with AHIMA–ACDIS query guidance required
- Experience using integrated electronic health records and CDI workflows, including readiness for transition from CDEOne to Epic CDI with planned go live in July 2027
- Minimum Required Experience: 5 Years
- Experience with analytics, reporting, and AI assisted review prioritization tools preferred
- Familiarity with DRG encoder and DRG validation tools including TruBridge preferred
Benefits
- Career growth and development opportunities, with clear pathways and ongoing support
- Comprehensive health and wellness resources that go beyond traditional benefits
- A wellness program that can help employees eliminate their medical plan deductible, reducing out-of-pocket healthcare costs
- Tuition reimbursement to support continued learning and advancement
Company Overview
Company H1B Sponsorship