Clinical Documentation Integrity DRG Validator

This is a fully remote position, open to applicants in Florida.

📋 Description

• Enhance the quality, thoroughness, and clinical precision of inpatient documentation and DRG assignment via focused concurrent DRG validation.

• Assess specific inpatient accounts typically over 48 hours post-admission that have not undergone DRG optimization.

• Employ integrated electronic health record workflows, technology-enabled review worklists, and analytics-driven prioritization to concentrate on documentation, clinical validation, and reimbursement risk.

• Evaluate non-optimized DRGs, signs and symptoms DRGs, APR-DRGs with SOI/ROM of 1/1 where the clinical scenario indicates higher acuity, local infection DRGs, sepsis DRGs, and discrepancies between level-of-care and DRG.

• Analyze accounts across all inpatient payors.

• Utilize analytics-driven prioritization, AI-assisted worklists, and DRG encoder logic, including TruBridge where applicable.

• Assist in Epic transition planning for CDI workflows with a planned go-live in July 2027.

• Work collaboratively with coding professionals.

⛳️ Requirements

• MD/DO degree.

• Certified Clinical Documentation Specialist (CCDS) or Certified Documentation Integrity Practitioner (CDIP) certification.

• Graduation from an international medical school is mandatory.

• A minimum of five years of recent experience in adult, pediatric, obstetric, inpatient medical, surgical, and critical care is required.

• Strong understanding of Medicare MS-DRG and Medicaid APR-DRG assignment, severity of illness, risk of mortality, clinical validation, denial vulnerabilities, and documentation integrity is essential.

• Proven experience in concurrent inpatient chart review, DRG validation, collaboration with coding professionals, and use of integrated electronic health records, web-based applications, and technology-driven review/analytics tools is required.

• Familiarity with official coding guidelines, AHA Coding Clinic, CMS guidance, payer clinical validation expectations, and compliant documentation clarification aligned with AHIMA–ACDIS query guidance is required.

• Experience with integrated electronic health records and CDI workflows, including readiness for transition from CDEOne to Epic CDI with a planned go-live in July 2027.

• Preferred experience with analytics, reporting, and AI-assisted review prioritization tools.

• Familiarity with DRG encoder and DRG validation tools, including TruBridge, is preferred.

• Minimum required experience: 5 years.

🏝️ Benefits

• Opportunities for career growth and development, with well-defined pathways and continuous support.

• Comprehensive health and wellness resources that extend beyond conventional benefits.

• A wellness program designed to help employees eliminate their medical plan deductible, thereby reducing out-of-pocket healthcare expenses.

• Tuition reimbursement to promote ongoing education and career advancement.