PPS Coordinator

4 weeks ago

Oklahoma City, United States INTEGRIS Health Full time
Job Description

INTEGRIS Health Southwest Medical Center, named the top hospital in the Oklahoma City metro by Newsweek, has a great opportunity for a PPS Coordinator in Oklahoma City, OK. In this position, you'll be a part of our [department] team providing exceptional work supporting the INTEGRIS Health caregivers and the community at large. If our mission of partnering with people to live healthier lives speaks to you, apply today and learn more about our recently enhanced benefits package for all eligible caregivers such as, front loaded PTO, 100% INTEGRIS Health paid short term disability, increased retirement match, and paid family leave. We invite you to join us as we strive to be The Most Trusted Partner for Health.

The Inpatient Rehabilitation Facility Patient Assessment Instrument ( IRF-PAI) Coordinator/ PPS Coordinator is a finance-related position requiring clinical skills to coordinate the process of providing accurate and timely data to the appropriate entities involved in the Prospective Payment System for inpatient rehabilitation patients. The IRF-PAI Coordinator oversees all aspects of data collection on the IRF PAI, ensures the presence of supporting documentation and provides staff education to ensure compliance with CMS guidelines. Responsible for coordinating all patient information to be submitted to CMS for Medicare reimbursement. Responsible for Utilization Review to maximize LOS efficiency. Coordinate and monitor compliance with 60% rule. Responsible for monitoring patient charts for correct coding and electronically transmitting data in a timely manner to maximize reimbursement. Monitor program compliance with charging for Medicare Services (CMS). In addition, this position participates with staff orientation and ongoing education to improve functional scoring accuracy at admission, throughout the stay, and upon discharge. Serves as a resource to licensed clinicians and clinical staff regarding questions and interpretation of scoring guidelines to assure the accuracy of scores.

Responsibilities

Job Responsibility:
  • Responsible for the accurate coordination and completion of the Inpatient Rehabilitation Facility Patient Assessment Instrument (IRF-PAI) and timely submission to CMS.
  • Reviews medical record documentation and 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.
  • Coordinates all efforts for immediate issue resolution concerning GG and H scoring and quality measures recorded on the IRF-PAI.
  • Conducts ongoing concurrent chart review of medical record and updates IRF-PAI as necessary.
  • Collaboration with IRF physicians to ensure accuracy and thoroughness of documentation, ensuring appropriate Impairment Group code and comorbidities are assigned; conducting documentation queries as needed.
  • Serve as a PPS resource, collaborating with JTR leadership, providing feedback on CMS regulatory requirements, documentation, scoring, and quality measures.
  • Collaboration with the business office to ensure timely, compliant processing of IRF accounts through the billing system.
  • Collaboration with Admissions and Clinical Liaisons with assistance in identification of compliant and appropriate rehab admissions.
  • Collaboration 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.
  • Collaboration 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.
  • Assist in 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.
Must:
  • Demonstrate excellent communication and customer services skills.
  • Possess strong critical thinking and time management skills.
  • Self-motivated to stay current with CMS IRF regulations and ICD-10-CM coding updates.
  • Be able to apply IRF-PAI guidelines for IP Rehabilitation medical coding while following official coding guidelines.
  • Possess a thorough knowledge of IRF-Manual.
  • Possess proficient computer skills.
Qualifications

Must be one of the following:
  • 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 health care setting; rehabilitation facility preferred.

Must be able to communicate effectively in English (verbal/written.

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