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

• Utilize integrated electronic health record workflows, technology-driven review worklists, and analytics-based prioritization.

• Concentrate on cases involving documentation, clinical validation, and reimbursement risks.

• Examine non-optimized DRGs as well as signs and symptoms DRGs.

• Assess APR-DRGs with a SOI/ROM of 1/1 where the clinical situation indicates higher acuity.

• Review local infection DRGs concerning sepsis or systemic illness.

• Analyze sepsis DRGs lacking documented organ dysfunction or other necessary clinical indicators.

• Identify mismatches between level-of-care and DRG, including ICU or step-down patients assigned to minor DRGs or SOI/ROM 1/1.

• Review all inpatient payors.

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

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

⛳️ Requirements

• MD/DO degree required.

• Certification as a Clinical Documentation Specialist (CCDS) or Certified Documentation Integrity Practitioner (CDIP) is mandatory.

• Graduate 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 is necessary.

• Strong understanding 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 the use of integrated electronic health records, web-based applications, and technology-enabled review/analytics tools is required.

• Knowledge of official coding guidelines, AHA Coding Clinic, CMS guidance, payer clinical validation expectations, and compliant documentation clarification in accordance with AHIMA–ACDIS query guidance is necessary.

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

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

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

• Minimum required experience: 5 years.

• EOE, including disability/vets.

🏝️ Benefits

• Opportunities for career growth and development, with clear pathways and continuous support.

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

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

• Tuition reimbursement available to support ongoing learning and advancement.