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 (160433) Job Description Clinical Documentation Integrity DRG Validator, REMOTE -Managed Care Network Development Med Mgmt, FT, 08:30A-5P - 160433 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. Estimated salary range for this position is $74,100.20 - $96,330.26 / year depending on experience. Qualifications Degrees: MD/DO Required Licenses and Certifications: Certified Clinical Documentation Specialist (CCDS) or Certified Documentation Integrity Practitioner (CDIP). 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 Miami Organization Corporate Schedule Full-time Job Posting Jul 14, 2026, 4:00:00 AM Unposting Date Ongoing EOE, including disability/vets For Patients & Visitors Appointments Pre-registration Find a Baptist Health Doctor Find Classes & Events Health Services Health Topics A to Z Hospitals & Facilities International Patients Online Bill Pay Volunteers News & Announcements Baptist Health Locations Baptist Hospital Baptist Children's Hospital Doctors Hospital Homestead Hospital Mariners Hospital South Miami Hospital West Kendall Baptist Hospital Miami Cardiac & Vascular Institute Search All Express & Urgent Care Centers Search All Diagnostic Centers Search All Primary Care Locations For Professionals For Employees For Physicians For Vendors For Alumni About Us About Baptist Health South Florida Contact Us Giving How We Perform For Physicians For Nurses For Employees Baptist Health is committed to providing reasonable accommodation to applicants with disabilities. If you want to apply for an open position and need an accommodation to complete the electronic employment application, please contact Human Resources at for assistance. 786-596-2290 Baptist Health South Florida is an Equal Employment Opportunity employer. Baptist Health prohibits any form of unlawful harassment or discrimination against applicants for employment or employees on the basis of race, color, religion, ancestry, sex, gender identity, gender expression, pregnancy, national origin, age, marital status, familial status, military/veteran status, disability status, genetic information with respect to the applicant or employee, sexual orientation, or any other classification/characteristic protected by applicable federal, state or local law. Notice of Privacy Practices Website Privacy Policy Terms of Use Sitemap