The PPS Coordinator is responsible for making sure the IRF-PAI is completed utilizing input from all disciplines. Responsible for managing reimbursement from Medicare and Managed Care companies. Provides training, education and communication to team members, medical providers, and various departments, which include Coding and Billing departments on reimbursement and PPS updates or changes. Mentors the team members, medical providers, and various departments, including Coding and Billing departments to guide for success. Responsible for ensuring processes and procedures are followed within the department.
Qualifications
EDUCATIONAL REQUIREMENTS
College Diploma in Practical Nursing or Certificate in Practical Nursing
CERTIFICATION & LICENSURE REQUIREMENTS
Licensed Practical Nurse (LPN) Illinois upon hire
ADDITIONAL REQUIREMENTS
1-3 years of clinical bedside experience
Rehab experience is highly preferred but not required
SKILLS AND KNOWLEDGE
Writes, reads, comprehends, and speaks fluent English.Basic computer knowledge using word processing, spreadsheet, email, and web browser. Multicultural sensitivityAdvanced reading, writing and oral skillsAbility to respond appropriately to customer/coworkerInteraction with a wide variety of peopleMaintain confidential informationAbility to communicate only the facts to recipients or to decline to reveal informationAbility to project a professional, friendly, helpful demeanorAbility to utilize PC including, basic elements of Windows environment, keyboarding, work with mouse, and perform basic computer tasks with instruction.Critical thinking skills using independent judgment in making decisions.
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.
- Patient's Care Tool is thoroughly reviewed for accuracy. Documentation of care given is evidenced 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, which include Coding and Billing departments on reimbursement and PPS updates or changes.
- Notifies appropriate staff of any discrepancies with admission or discharge documentation and requirements.
- Overseas all CMS IRF Quality Measures & Quality Reporting Program. Notifies appropriate staff regarding any discrepancies and corrects information as needed.
- 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 que 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 question 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.
About Us
Find it here.
Discover the job, the career, the purpose you were meant for. The supportive and inclusive team where you can thrive. The place where growth meets balance – and opportunities meet flexibility. Find it all at Carle Health.
Based in Urbana, IL, Carle Health is a healthcare system with nearly 16,600 team members in its eight hospitals, physician groups and a variety of healthcare businesses. Carle BroMenn Medical Center, Carle Foundation Hospital, Carle Health Methodist Hospital, Carle Health Proctor Hospital, Carle Health Pekin Hospital, and Carle Hoopeston Regional Health Center hold Magnet® designations, the nation’s highest honor for nursing care. The system includes Methodist College and Carle Illinois College of Medicine, the world’s first engineering-based medical school, and Health Alliance™. We offer opportunities in several communities throughout central Illinois with potential for growth and life-long careers at Carle Health.
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. | For more information: human.resources@carle.com.