PPS COORDINATOR

BEYOND HEALTH MANAGEMENT SOLUTIONS • McKinney, TX

2d • Onsite

About The Position

Horizon Rehabilitation Hospital in McKinney is an innovative, state-of-the-art facility dedicated to providing exceptional, patient-centered healthcare services to our community. As a newly established 26-bed in-patient rehab hospital, we are committed to setting new standards in patient care and rehabilitation. We value compassion, excellence, and teamwork, and we are looking for an experienced, detail-oriented PPS Coordinator to join our team.
Job Responsibilities:
The PPS Coordinator is responsible for coordinating, monitoring, and ensuring compliance with Medicare Inpatient Rehabilitation Facility (IRF) regulatory requirements, including IRF-PAI/PPS reporting and the CMS IRF Review Choice Demonstration (RCD) program administered by Novitas.
This role integrates clinical documentation review, regulatory compliance, data integrity, and medical review submission processes for Medicare Part B IRF RCD activities, including pre-claim review (PCR), post payment review, ADR management, appeals coordination, and audit readiness. The position serves as the primary operational liaison between the facility, Novitas, CMS, and internal clinical and billing teams.
At Horizon Rehabilitation Hospital we are dedicated to creating a positive and supportive work environment where our employees can thrive while making a difference in the lives of our patients. Join us in shaping the future of healthcare and rehabilitation. We look forward to welcoming you to our team!

Requirements

• Bachelor’s degree preferred.
• Minimum 1-year recent clinical experience in inpatient rehabilitation.
• Knowledge of regulatory standards and compliance requirements.

Nice To Haves

• Experience with medical review, audits, ADRs, or Medicare appeals strongly preferred.
• Knowledge of CMS IRF regulations, Medicare Part B billing, and Novitas processes preferred.

Responsibilities

• The PPS Coordinator is responsible for coordinating, monitoring, and ensuring compliance with Medicare Inpatient Rehabilitation Facility (IRF) regulatory requirements, including IRF-PAI/PPS reporting and the CMS IRF Review Choice Demonstration (RCD) program administered by Novitas.
• This role integrates clinical documentation review, regulatory compliance, data integrity, and medical review submission processes for Medicare Part B IRF RCD activities, including pre-claim review (PCR), post payment review, ADR management, appeals coordination, and audit readiness.
• The position serves as the primary operational liaison between the facility, Novitas, CMS, and internal clinical and billing teams.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Number of Employees: 101-250 employees