Clinical Documentation Integrity DRG Validator

🔥 0 minutes ago

🐊 Florida – Remote

🐊 Florida – Remote

💵 $74.1k - $96.3k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

🏥📝 Medical Writer

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Baptist Health

WebsiteLinkedInAll Job Openings

10,000+ employees

🏥 Healthcare

🤝 Non-profit

Healthcare • Non-profit

Baptist Health is the region's largest not-for-profit healthcare organization in South Florida. It operates 12 hospitals, more than 29,000 employees, 4,500 physicians, and roughly 200 outpatient centers, urgent care facilities, and physician practices across Miami-Dade, Monroe, Broward, and Palm Beach counties. The system includes renowned centers of excellence in cancer, heart and vascular, brain and spine, and orthopedic care, and is supported by philanthropy and a faith-based mission. Baptist Health emphasizes clinical quality, patient safety, staff development, and community-oriented care.

📋 Description

• Improve the quality, completeness, and clinical accuracy of inpatient documentation and DRG assignment through targeted concurrent DRG validation • Review selected inpatient accounts generally more than 48 hours from admission that have not been DRG optimized • Use integrated electronic health record workflows, technology-enabled review worklists, and analytics-informed prioritization to focus on documentation, clinical validation, and reimbursement risk • Review 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, sepsis DRGs, and level-of-care versus DRG mismatches • Review accounts across all inpatient payors • Use analytics-informed prioritization, AI-assisted worklists, and DRG encoder logic including TruBridge where implemented • Support Epic transition planning for CDI workflows with planned go-live in July 2027 • Collaborate with coding professionals

🎯 Requirements

• MD/DO degree • Certified Clinical Documentation Specialist (CCDS) or Certified Documentation Integrity Practitioner (CDIP) certification • 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 • Experience with analytics, reporting, and AI assisted review prioritization tools preferred • Familiarity with DRG encoder and DRG validation tools including TruBridge preferred • Minimum required experience: 5 years

🏖️ 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