Compliance RN Coordinator

Role Overview

The IRF-PAI Compliance Coordinator, RN ensures accurate completion of IRF-PAI assessments, compliance with Medicare and regulatory standards, and proper reimbursement in an Inpatient Rehab setting.

Responsibilities

• Reviewing admissions for medical necessity
• Monitoring documentation
• Coordinating team conferences
• Educating staff
• Managing denials
• Tracking data to support quality care and financial integrity
• Auditing patient records
• Ensuring documentation aligns with federal and state regulations
• Maintaining compliance with accreditation standards such as CARF and CMS
• Communicating effectively with physicians, ancillary departments, and payors to resolve issues and optimize reimbursement outcomes
• Participating in policy implementation
• Attending meetings
• Contributing to a positive team environment

Qualifications

• Minimum of two years of clinical experience
• Knowledge of JCAHO and regulatory requirements
• Degree in nursing or a related healthcare field

Skills

• Communication
• Advanced computer literacy
• Familiarity with healthcare compliance