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.
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