Prospective Payment System Coordinator / PPS Coordinator

Responsibilities

• Coordinating the process of providing accurate and timely data to the appropriate entities involved in the Prospective Payment System for inpatient rehabilitation patients.
• Accurately encodes appropriate Impairment Group Code (IGC) and ICD-10 diagnoses codes for Etiologic Diagnosis and Comorbid Conditions on the IRF-PAI.
• Ensures the presence of supporting documentation in the medical record.
• Provides clinical staff education to ensure documentation requirements are met in compliance with CMS guidelines.
• Collaborates with IRF physicians to ensure accuracy and thoroughness of documentation, ensuring appropriate Impairment Group code and comorbidities are assigned; conducts documentation queries as needed.
• Serve as a PPS resource, collaborating with JTR leadership, providing feedback on CMS regulatory requirements, documentation, scoring, and quality measures.
• Collaborates with the business office to ensure timely, compliant processing of IRF accounts through the billing system.
• Collaborates with Admissions and Clinical Liaisons with assistance in identification of compliant and appropriate rehab admissions.
• Collaborates with Corporate Compliance, assisting with appeals for inpatient rehab denials.
• Possess knowledge of The Joint Commission and CARF standards and assist in readiness and surveys as needed.
• Collaborates with the Quality Consultant in identification of patterns, trends, and key problematic areas with the ability to communicate specific opportunities for improvement to leadership.
• Tracking 60% rule compliance.
• Aid in the development of tactics and process improvement strategies to achieve financial and quality targets.
• Reports critical CMS updates and/or information, including IRF Care Compare results to JTR leadership.

Qualifications

• Current licensure as a Registered Nurse (RN) in the State of Oklahoma or current multistate license from a Nurse Licensure Compact (eNLC) member state.
• Current licensure as a Physical Therapist/Assistant in the State of Oklahoma.
• Current licensure as an Occupational Therapist/Assistant in the State of Oklahoma.
• Current licensure as a Speech/Language Therapist/Assistant in the State of Oklahoma.
• 2 years of experience in a healthcare setting, preferably in a rehabilitation facility.