Comprehensive Rehab PPS Coordinator
4 weeks ago
We are seeking a highly skilled and experienced PPS Coordinator to join our team at Carle Health. The successful candidate will be responsible for ensuring the completion of the IRF-PAI for each patient, regulating the PPS completion schedule of assessments, and maintaining current with changes to Prospective Payment System (PPS) reimbursement.
Key Responsibilities- Coordinates the completion of the IRF-PAI for each patient per state/federal guidelines to be used for the Medicare reimbursement system and quality reporting.
- Regulates the PPS completion schedule of assessments per CMS for appropriate reimbursement.
- Maintains current with changes to Prospective Payment System (PPS) reimbursement.
- Provides training, education, and communication to team members, medical providers, and various departments on reimbursement and PPS updates or changes.
- Notifies appropriate staff of any discrepancies with admission or discharge documentation and requirements.
- Oversees all CMS IRF Quality Measures & Quality Reporting Program.
- Ensures all team members, including various departments, are following the IRF procedures and regulations to remain in compliance with governing bodies.
- Reviews IRF EMR documentation for accuracy and completes the IRF-PAI per CMS regulations.
- Completes weekly transmission of IRF-PAIs to CMS per guidelines.
- Enters CMGs into the Rehab WQ in EMR following weekly transmission to CMS.
- Responsible for monitoring IRF work queue timely and efficiently.
- Completes weekly Team Conference report for the IDT.
- Determine process changes/education need from information provided by Patient Financial Services (billing denials, down coding, outlier payments, etc.).
- Notify IRF Leadership Team of any denials, trends. Manage any IRF denials and/or information requests.
- Accumulate data for finance department to be used to assess operations. Answer finance questions in a timely, appropriate manner.
- Manages UDS IRF software for documentation entry and electronic transmission.
- Reviews charts for Quality Assurance information and discrepancies, reporting to Rehab leadership, as needed.
- Initiates measures to improve patient outcomes. Works with team members for proper utilization of resources.
- Assists in identifying ways to improve patient outcomes. Identify deficiencies in care and report to leadership, as appropriate.
- Maintain all Illinois Dept. of Public Health (IDPH), Centers for Medicare & Medicaid Services (CMS) and Joint Commission standards. Ensures others are following appropriate procedures to remain in compliance with State and Federal agencies.
We are an Equal Opportunity Employer and do not discriminate against any employee or applicant for employment because of race, color, sex, age, national origin, religion, sexual orientation, gender identity, status as a veteran, and basis of disability or any other federal, state, or local protected class.
Carle Health participates in E-Verify and may provide the Social Security Administration and, if necessary, the Department of Homeland Security with information from each new employee's Form I-9 to confirm work authorization.
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Comprehensive Rehab PPS Coordinator
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