Prospective Payment Coordinator (Clinical) - Inpatient Rehab

American Addiction Centers•High Point, NC

18d•$36 - $53•Onsite

About The Position

The Prospective Payment Coordinator manages the data collection systems for IRF-PAI (Inpatient Rehabilitation Facility - Patient Assessment Instrument) and IRF-PPS (Medicare Inpatient Rehabilitation Facility - Prospective Payment System.) Responsible for the management of the Uniform Data System for Medical Rehabilitation (UDSMR) outcomes measurement system. These responsibilities include ensuring accurate and timely collection and transmission of data, collaborating with the interdisciplinary team to ensure complete and accurate documentation to support the data, educating the interdisciplinary team on FIM and Quality Indicators (QI) to ensure accurate data, and providing ongoing education to the interdisciplinary team related to the IRF-PAI and UDSMR systems and reports. This is a professional clinical position.

Requirements

Bachelor's degree in Nursing, Physical Therapy, Occupational Therapy, or Speech Therapy
Licensed in Nursing, Physical Therapy, Occupational Therapy, or Speech Therapy by the State of NC required
Three years' clinical/administrative experience in Inpatient Rehabilitation
CPR certification
MOAB (Management of Aggressive Behavior) certification
Excellent oral, written, and interpersonal communication skills
Computer skills
Knowledge of the Functional Independence Measure (FIM) and Quality Indicator (QI) scoring tools
Knowledge of accreditation standards and compliance requirements for inpatient rehabilitation
Ability to speak and hear for patient assessment to communicate effectively with patients, physicians, and staff
Sense of smell and touch for patient assessments
Manual finger dexterity for accurate documentation, administration of medications/treatments, and equipment operation
Ability to manage a high stress environment effectively, providing optimal patient care

Responsibilities

Assessment Admin - Establishes and maintains a schedule for timely completion of all admission and discharge patient assessment instruments. Ensures completion of the patient assessment instrument and supporting documentation within established timeframes. Performs/oversees accurate entry and coding of data. Performs/oversees electronic data transmission to CMS and Uniform Data System for Medical Rehabilitation (UDSMR) within established timeframes. Performs credentialing on the FIM Instrument and Quality Indicators as required by UDSMR. Reviews admission and discharge assessment data and supporting clinical documentation to validate the data on the patient assessment instrument. Recognizes variances in documentation and collaborates with interdisciplinary team members to ensure accuracy of documentation.
Communication - Communicates schedule for completion of patient assessment instruments to manager and billing department including CMG and date of transmission. Communicates expected Case Mix Group (CMG) and targeted length of stay based upon the admission patient assessment instrument to the interdisciplinary team at team conference.
Teamwork - Collaborates with interdisciplinary team members to ensure accuracy of data. Provides clinical expertise by collaborating with members of the interdisciplinary team. Follows up with interdisciplinary team members as needed related to the accuracy or timeliness of documentation/data and provides feedback to manager as indicated. Provides feedback to interdisciplinary team members on the clinical and financial management of Medicare patients in particular. Attends team conferences to identify additional coding opportunities. Assists Admissions Coordinator with IRC referrals and admissions process as needed and serves as back-up in his/her absence.
Billing Audits - Completes quarterly billing audits to determine accuracy of dates of service and to ensure that what was billed matches the services provided.
Customer Focus - Responsible for maintaining excellent rapport with all managed care company personnel and enhancing the work relationship as necessary. Communicates with managed care/insurance company personnel in a professional manner.
Compliance - Keeps abreast of regulatory or other changes that impact the IRF-PAI or UDSMR outcomes management system. Demonstrates knowledge and understanding of CARF standards and assists management with ongoing CARF preparation as requested. Attends conferences on a regular basis to ensure continued compliance with regulatory requirements, coding and billing requirements, and FIM requirements. Completes quarterly documentation audits to ensure compliance with regulatory requirements.
Reporting - Independently manipulates UDSMR outcomes management system to regularly generate and retrieve routine and on-demand reports for manager/director in order to assist in supporting decision making, process improvement, etc. Analyzes report information and identifies trends. Makes recommendations for process improvements as indicated.
Training & Education - Provides ongoing education to interdisciplinary team on the IRF-PAI and UDSMR outcomes management system, including providing in-services as needed to clarify issues or address variances and providing one-on-one coaching to improve the quality of data to maximize reimbursement and ensure accurate documentation of outcomes. Provides orientation on the IRF-PAI and the UDSMR outcomes management system to all new employees. Provides for staff training on the IRF-PAI, FIM Instrument, and QI as required by UDSMR.
Professionalism - Upholds a professional working relationship at all times and adheres to department rules. Practices teamwork and adheres to Standards of Behavior. Performs other duties as assigned by management.

Benefits

Advocate Health offers a comprehensive suite of Total Rewards: benefits and well-being programs, competitive compensation, generous retirement offerings, programs that invest in your career development and so much more – so you can live fully at and away from work, including:
Compensation Base compensation listed within the listed pay range based on factors such as qualifications, skills, relevant experience, and/or training
Premium pay such as shift, on call, and more based on a teammate's job
Incentive pay for select positions
Opportunity for annual increases based on performance
Benefits and more Paid Time Off programs
Health and welfare benefits such as medical, dental, vision, life, and Short- and Long-Term Disability
Flexible Spending Accounts for eligible health care and dependent care expenses
Family benefits such as adoption assistance and paid parental leave
Defined contribution retirement plans with employer match and other financial wellness programs
Educational Assistance Program