Payor Compliance Coordinator
Orange Park Medical Center - Orange Park, FL

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Position Summary : The role of the Payor Compliance Coordinator is to oversee and coordinate CDM, LCD/NCD processes, clinical research studies, and other charging and billing compliance activities at the hospital level and monitor for compliance. Qualifications
      Job Qualifications:

      Proficient with Interqual or Millman & Robertson UR criteria

      RN or equivalent License

      5 years experience in a hospital acute care setting performing: case management, utilization review or revenue integrity duties

      Ability to communicate and implement complex UM, billing regulations to interdisciplinary departments

      Ability to identify and solve problems related to payor compliance issues

      In addition to working with case management staff, works with CDI, quality, and physician leadership