Note: The job is a remote job and is open to candidates in USA. Baptist Health is a not-for-profit healthcare organization serving South Florida through hospitals, outpatient centers, urgent care facilities, and physician practices. The Clinical Documentation Integrity DRG Validator improves the quality, completeness, and clinical accuracy of inpatient documentation and DRG assignment by reviewing high-risk inpatient accounts, using analytics and electronic health record workflows, and supporting Epic CDI transition planning.
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
- Doctor of Medicine / DO
- ACDIS Certified Clinical Documentation Specialist
- AHIMA Certified Documentation Improvement Practitioner
- 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