Comprehensive Rehabilitation Coordinator

1 month ago


Peoria, Illinois, United States Carle Health Full time
Job Summary

The PPS Coordinator is responsible for ensuring the accurate completion of the IRF-PAI, utilizing input from all disciplines, and managing reimbursement from Medicare and Managed Care companies. This role provides training, education, and communication to team members, medical providers, and various departments on reimbursement and PPS updates or changes.

Key Responsibilities
  • Coordinates the completion of the IRF-PAI for each patient per state/federal guidelines for Medicare reimbursement and quality reporting.
  • Regulates the PPS completion schedule of assessments per CMS for appropriate reimbursement.
  • Reviews Patient's Care Tool for accuracy and documents care given on appropriate forms.
  • 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, notifying staff of any discrepancies and correcting information as needed.
  • Ensures all team members, including various departments, follow 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.
  • Determines process changes/education needs from information provided by Patient Financial Services (billing denials, down coding, outlier payments, etc.).
  • Notifies IRF Leadership Team of any denials, trends, and manages any IRF denials and/or information requests.
  • Accumulates data for finance department to assess operations and answers 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 and works with team members for proper utilization of resources.
  • Assists in identifying ways to improve patient outcomes, identifying deficiencies in care, and reporting to leadership as appropriate.
  • Maintains all Illinois Dept. of Public Health (IDPH), Centers for Medicare & Medicaid Services (CMS), and Joint Commission standards, ensuring others follow appropriate procedures to remain in compliance with State and Federal agencies.

Carle Health is an Equal Opportunity Employer and does 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.



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