Prospective Payment System Coordinator; Post Acute Rehab

Job Requirements

General Summary: A Prospective Payment System (PPS) Coordinator is responsible for IRF-PAI and CMS regulatory compliance in accordance with current regulations. Provides expert advice to organization and interdisciplinary rehab team and monitors admissions, length of stay, and clinical documentation for regulatory compliance.

Primary Responsibilities

• Completes the Inpatient Rehabilitation Facility-Patient Assessment Instrument (IRF-PAI) in accordance with current rules, regulations, and guidelines that govern the assessment.
• Selects the Impairment Group Code (IGC) based on review and interpretation of physician documentation.
• Works collaboratively with the Interdisciplinary Rehabilitation Team in developing a comprehensive assessment for each patient.
• Maintains and updates policies, procedures, and workflows that govern the development, use, and implementation of the IRF-PAI in collaboration with the department management.
• Evaluates and implements recommendations from committees/leadership as they pertain to the patient assessment and/or care plan functions of the unit.
• Counsels physicians and other providers on clinical documentation improvement.
• Develops, plans, and schedules in-service training classes with other provider educators to include assessment skills or techniques needed to complete the assessment functions of the unit.
• Makes determinations about the appropriateness and medical necessity of admissions, continued hospital stay, and use of ancillary services.
• Evaluates the accuracy, completion, and discrepancies of clinical documentation to ensure regulatory compliance.
• Reviews and monitors patient medical records for complete, timely, and accurate entries; provides technical assistance to staff regarding developing quality improvement indicators/monitors, measurement methodology, and charting technique.
• Facilitates the preparation of and serves as an IRF PPS CMS expert for regulatory audits and compliance surveys.
• Performs all other duties as assigned.

Work Experience

• Ability to gather and analyze data/reports, to assess the health status and needs of the patients, to develop/implement programs that support the goals of the patient assessment function, to gather/interpret data and identify discrepancies, problems or issues, to recommend action plans based on findings, to obtain advice when precedents are unclear or unavailable and to determine methods for ensuring compliance with policies and procedures.
• High level of communication and/or interpersonal skills to relay quality improvement information via complex reports/presentations, and for contacts with physicians, therapists, nursing staff, patients, and families to discuss assessment information.
• Some tact, discretion, and conflict resolution skills are exercised. Courtesy and listening skills are required.
• The ability to read and comprehend procedures and technical literature in specific functional area is necessary.
• Able to cope with stressful situations or encounters and manage multiple and sometimes conflicting priorities.
• Leadership skills, including demonstrated willingness to pursue leadership roles with increasing levels of accountability, comfort with decision-making responsibilities, coaching, teaching, and counseling skills, and the ability to inspire and build confidence in others and to forge alliances and garner support.
• Technical knowledge of quality improvement/utilization review procedures and processes, and financial requirements of Medicare, Medicaid, and managed care organizations (including HMOs).
• Knowledge and skills necessary to prepare written reports regarding analyses and study findings, to prepare and deliver in-service curriculums to varied audiences, and to apply legal and regulatory requirements related to quality assurance/utilization review.
• Organizational skills to plan and implement training programs, policies, and procedures for the function, etc., and to ensure patient assessments are done completely, accurately, and timely.
• Ability to utilize computer systems, computer skills, and knowledge of various word processing, spreadsheet, and database software packages.

Minimum Education, Experience, And Licenses/Certifications Required

• Bachelor’s degree in physical therapy, occupational therapy, or speech language pathology, or a bachelor’s degree in nursing.
• Master’s degree in physical therapy, occupational therapy, or speech language pathology; or nursing preferred.
• Current active licensure in the State of Maryland as a Physical Therapist (PT), Occupational Therapist (OT), Speech Language Pathologist (SLP), or Registered Nurse (RN).
• Two (2) years of inpatient rehabilitation or acute care experience, including progressively more responsible clinical and/or quality assurance/utilization review experience.
• Coursework and experience in research statistics, and quality improvement methodology, including chart control techniques, preferred.

Benefits

All your information will be kept confidential in accordance with EEO guidelines.

Compensation

Full-Time; Days - Post Acure Rehab (M-F)
Pay Range: $38.67 - $58.05/hr. (Exempt)
Other Compensation (if applicable): NA

Review UMMS Benefits Overview:2026-2027 New Hire Benefits.pdf