RN, Clinical Documentation Integrity Specialist - Jupiter, FL (Hybrid Schedule)

Ensemble is a leading provider of technology-enabled revenue cycle management solutions for health systems, including hospitals and affiliated physician groups. They offer end-to-end revenue cycle solutions as well as a comprehensive suite of point solutions to clients across the country. Ensemble keeps communities healthy by keeping hospitals healthy.

About the role

The CDI Specialist facilitates and obtains appropriate physician documentation for any patient clinical condition or procedure to support the appropriate severity of illness, expected risk of mortality, and complexity of care as documented in patient medical records. Extensive medical record review and interaction with physicians, nursing staff, other patient caregivers, and HIM coding professionals is done to ensure the documentation is complete and accurate.

Responsibilities

• Completes initial patient medical record review within 24-48 hours of patient's admission; completes subsequent reviews of patient's medical record every 24-48 hours and enters review findings in CDE software system.
• Assigns Principal diagnosis, CC/MCC (complication and comorbidity/major complication and comorbidity), evaluates for Severity of Illness (SOI) and Risk of Mortality (ROM) on all patients while in-house. Assigns working ICD-10-CM and PCS codes and DRG (Diagnosis Related Group) using encoder in CDE software.
• Clarifies with physicians regarding missing, unclear, unsupported, or conflicting health record documentation by requesting and obtaining additional documentation from physicians when needed. Face-to-face physician interaction and written clarifications are used.
• Educates key healthcare providers such as physicians, nurse practitioners, allied health professionals, nursing, and care coordination regarding clinical documentation improvement, documentation guidelines, and the need for accurate and complete documentation in the health record.
• Partners with coding professionals to ensure accuracy of diagnostic and procedural data and completeness of supporting documentation to determine the working and final DRG assignment. Reviews DRG denial letters and writes denial appeal letters.
• Collaborates with care coordination, nursing staff, and other ancillary staff regarding interaction with physicians on documentation and to resolve physician clarifications prior to patient discharge.
• Maintains and upholds all clinical documentation regulatory guidelines.
• Formulates and submits timely, well-prepared appeals for reconsideration by third-party administrators (payors), including supporting documented clinical evidence, Coding/CDE Guidelines, and other regulatory standards/guidelines as appropriate.
• Works collaboratively with coworkers and management to effectively resolve root cause issues that impact payor contracts, hospital operations, or departmental operations to maintain reimbursement and minimize appeal requests and/or denials.

Requirements

• Minimum of five years acute care nursing experience with specific medical/surgical, Intensive Care, or Emergency Department experience.
• Excellent interpersonal skills including excellent verbal and written communication skills; proficient in and demonstrate excellent physician relations.
• Ability to organize and present information clearly and concisely; excellent computer and keyboarding skills; high degree of prioritization skills.
• Must be inquisitive and demonstrate openness to innovation including AI to explore better processes and ways to alleviate friction and improve patient and client experiences.
• Current RN Licensure.
• HFMA Certified Revenue Cycle Representative (CRCR) within 9 months of hire.

Schedule

This position requires working onsite at Jupiter Medical Center in Jupiter, FL two (2) days per week on a rotating schedule. Candidates must reside within a reasonable commuting distance and be able to reliably meet onsite work requirements.

Pay

The Base Salary for this role is $80,000.

Benefits

• Bonus Incentives
• Paid Certifications
• Tuition Reimbursement
• Comprehensive Benefits
• Career Advancement
• Associate Benefits – Comprehensive benefits package designed to support the physical, emotional, and financial health of you and your family, including healthcare, time off, retirement, and well-being programs.
• Culture – Ensemble is a place where associates can do their best work and be their best selves. The culture is rooted in collaboration, growth, and innovation.
• Growth – Investment in professional development. Each associate will earn a professional certification relevant to their field and can obtain tuition reimbursement.
• Recognition – Quarterly and annual incentive programs for all employees who go beyond and keep raising the bar for themselves and the company.

About Ensemble

Ensemble is an award-winning company recognized for excellence in revenue cycle management:

• Five-time winner of “Best in KLAS” (2020-2022, 2024-2025)
• Black Book Research's Top Revenue Cycle Management Outsourcing Solution (2021-2024)
• 22 Healthcare Financial Management Association (HFMA) MAP Awards for High Performance in Revenue Cycle (2019-2024)
• Leader in Everest Group's RCM Operations PEAK Matrix Assessment (2024)
• Clarivate Healthcare Business Insights (HBI) Revenue Cycle Awards for strong performance (2020, 2022-2023)
• Energage Top Workplaces USA (2022-2024)
• Fortune Media Best Workplaces in Healthcare (2024)
• Monster Top Workplace for Remote Work (2024)
• Great Place to Work certified (2023-2024)