Clinical Document Integrity Specialist , Managed Care Network Development Med

Benefits

• 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

Responsible for improving the overall quality and completeness of clinical documentation through concurrent review of inpatient records to support accurate code assignment, severity of illness and risk of mortality capture, quality outcomes, and appropriate reimbursement. Facilitates documentation modifications through interaction with physicians, nursing and other caregivers, and coding staff to ensure the record accurately reflects services rendered and the patient’s clinical condition for DRG-based payers.

Uses integrated health record workflows, technology-supported review worklists, and data-informed insights to identify documentation opportunities and support timely, compliant clarification of missing, inconsistent, or unclear documentation. Ensures the accuracy and completeness of information used for measuring and reporting provider and medical center outcomes and educates the care team on documentation best practices, regulatory expectations, and clinical documentation integrity goals. 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 Tru Bridge. Estimated salary range for this position is $71,940.93 - $93,523.21 / year depending on experience.

Degrees:

• MD / DO.

Additional Qualifications:

• International medical graduates required; BSN-prepared RN may be considered per organizational requirements.
• Three years of recent adult, pediatric, obstetric, inpatient medical, surgical, and critical care experience required.
• Knowledge of legal aspects of coding;
  Medicare MS-DRG and Medicaid APR-DRG assignment; severity of illness, risk of mortality; documentation integrity, utilization, quality, and case management, discharge planning, managed care, and denial prevention preferred.
• Experience with integrated EHRs, web-based applications, Inter Qual or similar tools, and technology-enabled workflow/analytics preferred.
• Basic Windows-based computer skills required.
• Knowledge of official coding guidelines, AHA Coding Clinic, CMS guidance, and compliant documentation clarification aligned with AHIMA-ACDIS query guidance, with effective collaboration with coding professionals, 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 Tru Bridge preferred.

Minimum

Required Experience:

3 Years

All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability or protected veteran status.