Pediatric CDI Specialist - Pediatric Resource Group (PRG)

About the Company

At Pediatric Resource Group (PRG), your work makes a meaningful impact on the care of pediatric patients. Pediatric healthcare has unique clinical, operational, documentation, quality, and reimbursement needs. PRG partners with children’s hospitals and pediatric programs to develop and optimize Clinical Documentation Integrity and Physician Advisor programs, helping ensure documentation accurately reflects patient acuity, strengthens quality and operational outcomes, and supports appropriate reimbursement. PRG’s team includes physicians, nurses, and pediatric healthcare leaders from across the country who understand the clinical and operational challenges facing children’s hospitals and pediatric programs. Many of our experts continue to care for patients, participate in research, educate trainees, and serve in clinical and administrative leadership positions at children’s hospitals. As part of Enjoin—a Great Place to Work® Certified organization for three consecutive years—PRG is dedicated to creating an environment where our people can do their best work while making a real difference.

About the Role

The Pediatric Clinical Documentation Integrity Specialist (Pediatric CDIS) serves as a clinical documentation integrity expert focused on pediatric patient populations. This position partners with physicians, advanced practice providers, coding professionals, and healthcare leaders to improve the completeness, specificity, and clinical accuracy of pediatric medical records. The Pediatric CDIS performs concurrent and retrospective reviews to ensure documentation accurately reflects patient acuity, severity of illness, risk of mortality, medical necessity, quality measures, and the complexity of care provided. This position also serves as an educator and consultant, promoting clinically supported documentation that contributes to compliant coding, accurate reimbursement, quality outcomes, and exceptional pediatric patient care.

Responsibilities

• Perform concurrent and retrospective reviews of pediatric medical records to evaluate documentation completeness, clinical specificity, and accuracy
• Identify documentation opportunities related to pediatric diagnoses, procedures, complications, comorbidities, severity of illness, risk of mortality, medical necessity, and quality measures
• Evaluate pediatric documentation using applicable clinical indicators, ICD-10-CM/PCS guidelines, Official Coding Guidelines, and regulatory requirements
• Ensure documentation accurately reflects the complexity of pediatric patient care and supports compliant code and DRG assignment
• Develop compliant provider queries to clarify incomplete, conflicting, nonspecific, or clinically unsupported documentation
• Follow up on outstanding queries and escalate them when appropriate
• Educate pediatric physicians, advanced practice providers, residents, and multidisciplinary healthcare teams on documentation requirements and best practices
• Build collaborative relationships with pediatric providers to strengthen documentation quality and clinical reliability
• Participate in provider education sessions, case reviews, and documentation improvement initiatives
• Partner with pediatric coding professionals to align clinical documentation with accurate code and DRG assignment
• Collaborate with quality, compliance, revenue cycle, and client teams to improve documentation and quality outcomes
• Identify documentation trends and opportunities for targeted provider education
• Maintain accurate and timely records of reviews, queries, interventions, and outcomes
• Meet established productivity, quality, accuracy, and turnaround-time expectations
• Participate in second-level reviews, peer reviews, quality audits, DRG reconciliation, and continuous improvement initiatives
• Support client reporting, special projects, and other pediatric CDI initiatives as assigned
• Maintain current knowledge of pediatric coding guidelines, reimbursement methodologies, quality measures, and regulatory updates
• Protect the confidentiality and security of patient, physician, employee, and client information

Requirements

• Minimum of three years of clinical documentation integrity experience
• At least one year of clinical documentation integrity experience focused specifically on pediatric patient populations
• Strong understanding of pediatric physiology, disease processes, treatments, clinical indicators, and documentation requirements
• Experience reviewing pediatric medical records and identifying documentation and query opportunities
• Working knowledge of ICD-10-CM/PCS, Official Coding Guidelines, MS-DRG and APR-DRG methodology, severity of illness, risk of mortality, medical necessity, and quality reporting
• Knowledge of compliant query practices and applicable AHIMA and ACDIS guidance
• Ability to evaluate complex pediatric medical records using sound clinical judgment and critical-thinking skills
• Experience collaborating with physicians, advanced practice providers, coding professionals, and multidisciplinary healthcare teams
• Strong written, verbal, interpersonal, and provider-education skills
• Excellent analytical, organizational, and problem-solving abilities
• Proficiency with electronic health records and CDI software
• Ability to work independently in a remote environment while managing multiple priorities and consistently meeting quality and productivity expectations
• One or more of the following active credentials:
  • Registered Nurse (RN)
  • Certified Clinical Documentation Specialist (CCDS)
  • Certified Documentation Integrity Practitioner (CDIP)

Preferred Qualifications

• Experience reviewing NICU or PICU encounters
• Experience performing second-level reviews, peer reviews, quality audits, mortality reviews, or DRG reconciliation
• Experience educating and engaging pediatric physicians and advanced practice providers

Work Environment & Schedule

• Fully remote, full-time (40 hours per week) or part-time (flexible)
• Company-issued equipment provided (for full-time employees only)
• Dedicated secure home workspace required
• High-speed internet connection required
• Strict adherence to HIPAA Privacy and Security requirements
• Ability to work independently while maintaining productivity and quality expectations

Benefits

• Comprehensive medical, dental, and vision insurance
• 401(k) with company match
• Generous paid time off plus eight paid holidays
• 100% remote work environment with company-provided equipment
• Professional development, continuing education, leadership training, and internal career growth opportunities
• Complimentary annual CEUs
• Access to advanced coding education and learning resources
• Employee wellness resources and discount programs
• Referral bonus opportunities
• White glove onboarding designed to set you up for success
• A collaborative, people-first culture proudly recognized as a Great Place to Work® Certified organization