Clinical Document Integrity Specialist 1, Managed Care Network Development Med Mgmt-Baptist Main, FT, 8:30A-5P

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.

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 TruBridge. Estimated salary range for this position is $71940.93 - $93523.21 / 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, InterQual 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 TruBridge preferred. Minimum Required

Experience

3 Years EOE, including disability/vets