New Jersey Licensed CDI Specialist

Job Summary

To support accurate DRG assignments, the remote Clinical Documentation Integrity DRG Downgrade Specialist will review and analyze payer-initiated DRG downgrades, prepare appeals, and collaborate with healthcare teams to enhance documentation quality and compliance.

Key responsibilities

• Analyze payer DRG downgrade notifications and conduct comprehensive medical record reviews to ensure accuracy in diagnosis and DRG assignment
• Write and submit evidence-based appeal letters, tracking each case through the appeal lifecycle
• Collaborate with internal teams to clarify documentation and provide feedback to improve provider practices

Required qualifications

• Bachelor's degree in Nursing required
• Minimum of 3 years of experience in an inpatient clinical documentation improvement role
• RN license and CCDS and/or CDIP certification required
• Minimum of 5 years nursing experience in adult acute care settings
• Deep knowledge of ICD-10-CM/PCS and experience managing DRG downgrades