Clinical PPS Coordinator-Inpatient Rehab

Clinical PPS Coordinator-Inpatient Rehab

Requirements

• Bachelor’s Degree Physical Therapy, Occupational Therapy, or Speech Therapy; Or
• Master’s Degree Physical Therapy, Occupational Therapy, or Speech Therapy.
• 5 Years rehab experience in a clinical setting as a licensed PT, OT, or SLP.
• IRF PPS Certification required within 1 year of hire date.

Responsibilities

• Ensures integrity and maintains accuracy of the patient demographic database.
• Maintains database of all patients evaluated for admission to rehab, including patients not admitted, for reporting purposes, utilization review, marketing, and rehab administration and in compliance with TJC and CARF.
• Maintains all data pertinent to admitted patients for evaluation of rehab services.
• Exports data for monthly discharge reports, quarterly financial reports chart review and on ad hoc basis.
• Creates ad-hoc and scheduled reports requested by rehab director, managers, marketing, case managers, and clinical evaluators.
• Demonstrates an awareness of the importance of comprehensive patient assessment as the foundation for planning and delivering care to patients in inpatient rehabilitation.
• Understands the CMG classification system and assures the appropriate documentation to support accurate financial reimbursement.
• Conducts chart reviews and identify potential tiers.
• Identifies and solves problems related to the IRF-PAI process and communicates issues promptly to Manager when appropriate.
• Enhances professional growth and development through participation in educational programs, current literature, inservice meetings, and workshops.
• Educates staff on accurate scoring of all sections of the IRF PAI including GG scoring. Identifies any inaccuracies with documentation and score recorded.
• Attends meetings as required.
• Orients, instructs, and trains additional personnel to coordinate and transmit IRF-PAI information.
• Assists Physicians and clinical evaluators with rehab impairment code selection and etiology. Send queries as needed. May be asked to perform rehab screens to ensure criteria is met and patient has a rehab diagnosis/assigned impairment code.
• Submits patient outcome data and follow-up data in a timely fashion.
• Ensures that all patient outcome data is transmitted to UDS for quarterly reporting to CMS.
• Organizes time and prioritizes workload to meet important deadlines.
• Uploads three-month follow-up data on a quarterly basis, ensures accuracy of data received, identifies errors, and makes corrections where necessary.
• Reviews follow up data and outcomes with management and staff. Identifies trends and supports leadership in creating strategies for improvement.
• Produces ad-hoc and scheduled reports for Rehab Management as needed.
• Maintains accuracy and completion of PPS Data.
• Completes chart reviews and inputs clinical information directly into the IRF PAI.
• Reviews coding by staff and sends queries as needed.
• Oversees/completes and assures the accuracy of the IRF-PAI prior to electronic transmission.
• Performs final coding review of Medicare patients for accuracy of assigned impairment code, diagnosis, CMG, comorbidities and complications through review of Physician’s History and Physical, consults, discharge summary, and Medical Records Coding Abstract.
• If discrepancies or errors are identified, recommend changes as needed to internal case manager/staff.
• Ensures that documentation relative to IRF-PAI is maintained according to federal and state regulations and organizational policies and procedures.
• Assists leadership with CARF accreditation including gathering of information, preparation, documentation, and presentation.
• Ensures Regulatory guidelines are met with rehab cases and assists Leadership as needed with duties.
• Responsible for the coordination of interdisciplinary team conference scheduling with physicians, case managers, inpatient treatment team, and patient/family.
• Demonstrates commitment to quality and operational excellence through continuous improvement.
• Anticipates change and demonstrates flexibility in work practices.
• Effectively makes timely decisions focused on performance and results.
• Actively practices safe work habits and contributes to ensuring a safe work environment.
• Educates all new staff on PPS policies and appropriate completion of IRF-PAI and provides ongoing education.
• Completes internal regulatory chart audits and reviews with management.
• Identifies and implements process improvement strategies to streamline data collection, improve accuracy, and enhance overall patient care.
• Embraces new ideas and is proactive implementing them under the guidance of management.
• Notifies appropriate resources when issues or problems arise.
• Completes quality assurance monitoring tools as specified in the department.
• Utilizes appropriate processes or tools to document identified problems to promptly initiate problem-solving plans.
• Promotes quality outcomes in complex, new/unusual, or other high-risk clinical situations, collaborating or seeking additional resources as needed.
• Ensure accuracy, completion, and transmission of the IRF-PAI and performs pre-billing functions for all inpatient Rehab Medicare patients.
• Maintains a tracking calendar. Schedules and ensures electronic transmission of the IRF-PAI according to PPS reimbursement guidelines.
• Ensures that all transmissions are archived according to policy and are available to review for up to 5 years.
• Ensures hospital work queues related to PPS are consistently monitored and addressed.

Preferred Qualifications

• Other : Medical Terminology, Medical Coding and/or healthcare related courses.
• California Licensed Physical Therapist (PT) – CA Physical Therapy Board -PREFERRED
• California Occupational Therapist license – CA Board of Occupational Therapy -PREFERRED
• California Speech-Language Pathologist – CA Speech-Language Pathology & Audiology & Hearing Aid Dispensers Board -PREFERRED