Clinical Documentation Integrity DRG Validator, REMOTE, Managed Care Network Development Med Mgmt, FT, 08:30A-5P

Job Description - Clinical Documentation Integrity DRG Validator, REMOTE, Managed Care Network Development Med Mgmt, FT, 08:30A-5P (161844)

Job Description

Clinical Documentation Integrity DRG Validator, REMOTE, Managed Care Network Development Med Mgmt, FT, 08:30A-5P-161844

Baptist Health is the region''s largest not-for-profit healthcare organization, with 12 hospitals, over 29,000 employees, 4,500 physicians and 200 outpatient centers, urgent care facilities and physician practices across Miami-Dade, Monroe, Broward and Palm Beach counties. With internationally renowned centers of excellence in cancer, cardiovascular care, orthopedics and sports medicine, and neurosciences, Baptist Health is supported by philanthropy and driven by its faith-based mission of medical excellence. For 26 years, we''ve been named one of Fortune''s 100 Best Companies to Work For, and in the 2025-2026 U.S. News & World Report Best Hospital Rankings, Baptist Health was the most awarded healthcare system in South Florida, earning 63 high-performing honors.

What truly sets us apart is our people. At Baptist Health, we create personal connections with our colleagues that go beyond the workplace, and we form meaningful relationships with patients and their families that extend beyond delivering care. Many of us have walked in our patients'' shoes ourselves and that shared experience fuels out commitment to compassion and quality. Our culture is rooted in purpose, and every team member plays a part in making a positive impact - because when it comes to caring for people, we''re all in.

At Baptist Health, we're committed to supporting our employees at every stage of their journey, both personally and professionally. Our approach is rooted in a "grow our own" philosophy, designed to help our team members build meaningful, long-term careers with us, supported by benefits that make a real difference, including:

• 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
• And so much more

Together, these benefits and others reflect our commitment to caring for our people, so they can build fulfilling careers with us while making a meaningful impact every day.

Description

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.

Qualifications

Degrees:

• Doctor of Medicine / DO.

Licenses & Certifications:

• ACDIS Certified Clinical Documentation Specialist.
• AHIMA Certified Documentation Improvement Practitioner.

Additional Qualifications:

• 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

Job

Corporate

Primary Location

Coral Gables

Organization

Corporate

Schedule

Full-time

Job Posting

Aug 25, 2026, 9:30:00 AM

Unposting Date

Ongoing

EOE, including disability/vets