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 through focused concurrent DRG validation.

• Examine selected inpatient accounts typically more than 48 hours post-admission that have not undergone DRG optimization.

• Leverage integrated electronic health record workflows, technology-enabled review worklists, and analytics-driven prioritization to concentrate on cases with the highest risks related to documentation, clinical validation, and reimbursement.

• Analyze non-optimized DRGs, signs and symptoms DRGs, APR-DRGs with SOI/ROM of 1/1 where the clinical scenario indicates greater acuity, local infection DRGs for sepsis or systemic illness, sepsis DRGs lacking documented organ dysfunction or necessary clinical indicators, and discrepancies between level-of-care and DRG.

• Review accounts across all inpatient payors.

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

• Assist in planning the transition to Epic for CDI workflows, with a scheduled go-live in July 2027.

⛳️ Requirements

• Doctor of Medicine / DO.

• ACDIS Certified Clinical Documentation Specialist.

• AHIMA Certified Documentation Improvement Practitioner.

• Graduation from an international medical school is required.

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

• In-depth knowledge of Medicare MS-DRG and Medicaid APR-DRG assignment, severity of illness, risk of mortality, clinical validation, denial vulnerability, and documentation integrity is essential.

• Experience in concurrent inpatient chart review, DRG validation, collaboration with coding professionals, and using integrated electronic health records, web-based applications, and technology-enabled review/analytics tools is mandatory.

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

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

• Experience with analytics, reporting, and AI-assisted review prioritization tools is preferred.

• Knowledge of DRG encoder and DRG validation tools, including TruBridge, is preferred.

🏝️ Benefits

• Opportunities for career growth and development, with defined pathways and ongoing support.

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

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

• Tuition reimbursement to promote continued education and professional advancement.