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WVU Medicine · 10 hours ago

Prospective Payment System Coordinator

Morgantown, WV

Part-time

Onsite

Entry, Mid Level

2+ years exp

WVU Medicine is a healthcare provider focused on rehabilitation services, and they are seeking a Prospective Payment System Coordinator. The role involves planning and coordinating activities related to the Prospective Payment System process for the inpatient rehabilitation unit, ensuring compliance with regulations, and providing staff education and training.

Health CareHospitalMedical

Responsibilities

Completes and transmits the IRF-PAI to CMS

Oversees and ensures the accuracy and completion of the Inpatient Rehabilitation Facility-Patient Assessment Instrument (IRF-PAI) prior to electronic transmission within required time frames

Maintains a current knowledge of IRF-PAI software and provides expertise on this software within the inpatient rehab setting

Collaborates with rehab liaison/case manager and admitting physician to determine the anticipated case mix group (CMG) to be assigned to each patient admitted

Collects pertinent demographic, clinical and care set data and enters it on the IRF-PAI

Ensures Preadmission Screen is completed (PASE) and signed with 48 hours of IRF admit

Ensures HPI completed as required for IRF documentation and as required under the conditions of participation

Ensures Individualized Overall Plan of Care includes CMS required documentation and is completed with 4 days of IRF admit

Tracks, monitors and reports Intense Level of Rehabilitation Services and individualized care

Communicates with coders within 4 days of admission to determine etiologic diagnosis and co-morbid conditions present on admission

Communicates estimated length of stay and expected outcomes to the team and to case manager for discharge planning and discussion at case conference

Participates in all care conferences and reviews documentation concurrently throughout the stay to ensure accurate documentation of team conference discussion. Reviews codes as provided by health information management for capture of documented conditions

Tracks and reports regularly on 60% rule compliance

Maintains a current knowledge of CMS and PPS regulations related to participation requirements for inpatient rehabilitation facilities

Provides ongoing staff education to ensure compliance with CMS guidelines

Collaborates with interdisciplinary members of the team

Assists with formulating a plan of care including expected outcomes for each patient based on diagnoses derived from patient assessments

Educates and trains staff, including physician, nurses and therapists, on documenting to ensure that the plan of care and supporting documentation reflects the need for intensity of services provided, medical necessity of the services provided and need for 24-hour rehab nursing

Educates and trains staff to accurately score IRF PAI and GG section

Completes competency check off for Care Set coding (GG section) on all new rehab staff

Reviews documentation for inconsistencies in Care Set coding

Ensures completion of Care set coding re-credentialing for facility and all appropriate staff members

May serve as a scribe in care conferences

Promotes participation, cooperation, and teamwork. Demonstrates problem solving in resolving issues

Participates in Quality Improvement Activities

Prepares data for program development and rehab operations meetings

Data Analysis: runs monthly reports on multiple outcome measures and CMS compliance; performs data analysis and develops action plans to ensure optimal patient outcomes with targets to exceed regional benchmarks

Identifies performance improvement opportunities in collaboration with the rehabilitation leadership team

Actively participates in the development, implementation and evaluation of quality improvement action plans/monitoring

Actively participates in the development/modification and implementation of rehabilitation policies and procedures

Tracks and reports regularly on outcomes data generated through IRF-PAI submissions

Attends facility quality improvement meetings as required

Qualification

IRF PAI CoordinationClinical ExperienceBLS CertificationCMS RegulationsData AnalysisMedical TerminologyCustomer ServiceComputer ProficiencyMedicare PPS KnowledgeEffective CommunicationInterpersonal SkillsAttention to Detail

Required

ADN, Diploma, BSN or higher degree OR equivalent professional degree in Physical Therapy, Occupational Therapy, or Speech Language Pathology

Current Registered Nurse license issued by the state in which services will be provided or current multi-state Registered Nurse license through the enhanced Nurse Licensure Compact (eNLC), OR

Physical Therapist License through West Virginia Board of Physical Therapists OR Physical Therapist Compact License , OR

Occupational Therapist License through West Virginia Board of Occupational Therapy, OR

Licensed Speech Language Pathologist License through the West Virginia Board of Speech-Language Pathology & Audiology

Obtain BLS within 30 days of hire

Two (2) years clinical experience, including experience as a IRF PAI Coordinator and previous experience with UDS

Effective verbal and written communication skills

Strong interpersonal skills

Strong attention to detail

Knowledge of medical terminology required

Knowledge of third party payers required

Ability to use tact and diplomacy in dealing with others

Working knowledge of computers