Clinical Document Integrity Specialist 2, Managed Care Network Development Med Mgmt-Boca Raton, FT, 8:30A-5P

Responsible for improving overall quality and completeness of clinical documentation through advanced concurrent review of inpatient records to support accurate, clinically valid code assignment, severity of illness and risk of mortality capture, quality outcomes, and appropriate reimbursement. Facilitates documentation modifications through extensive interaction with physicians, nursing, other caregivers, and coding staff to ensure documentation accurately reflects services rendered and the patient’s clinical condition for DRG-based payors. Uses integrated health record workflows, technology-enabled review worklists, and data-informed insights to prioritize cases with the greatest documentation and clinical validation impact, ensuring accuracy of information used to measure and report provider and medical center outcomes. Provides ongoing education and coaching on documentation, best practices, regulatory expectations, and program goals and participates in team meetings and continuous improvement activities. Scope to include all inpatient payors including Medicare, Medicare Advantage, commercial, Exchange, and other applicable payors. Uses technology supported worklists, analytics, and AI assisted prioritization where available. Supports transition from CDEOne to Epic CDI workflows with planned go live in July 2027 and collaborates on DRG encoder integration such as TruBridge. 

Degrees:

• MD / DO.

Licenses & Certifications:

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

Additional Qualifications:

• International medical school graduates preferred; RN with advanced degree (MBA or related) may be considered. 
• Four years of recent adult, pediatric, obstetric, inpatient medical, surgical, and critical care experience, plus five years of CDI experience in adult/pediatric inpatient and critical care settings required. 
• I preferred CDI certification (CCDS or CDIP). 
• Experience with integrated EHRs, web-based applications, InterQual or similar tools, and technology-enabled workflow and analytics preferred. 
• Leadership experience and knowledge of legal aspects of coding; Medicare MS-DRG and Medicaid APR-DRG; utilization and case management, discharge planning, and managed care preferred. 
• Basic Windows-based computer skills required. 
• Knowledge of official coding guidelines, AHA Coding Clinic, CMS guidance, 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

EOE, including disability/vets