Prospective Payment Coordinator

University of Utah Health•Salt Lake City, UT

10d•Onsite

About The Position

As a patient-focused organization, University of Utah Health exists to enhance the health and well-being of people through patient care, research and education. Success in this mission requires a culture of collaboration, excellence, leadership, and respect. University of Utah Health seeks staff that are committed to the values of compassion, collaboration, innovation, responsibility, integrity, quality and trust that are integral to our mission. EO/AA This onsite position oversees all aspects of data collection for the Inpatient Rehab Facility-Patient Assessment Instrument (IRF-PAI) , ensuring the presence of supporting documentation and associated assignment of accurate and defendable impairment and Case Mix Group (CMG) code assignment, as well as accurate scoring of functional status, in accordance with Center for Medicare & Medicaid Services (CMS) guidelines. In addition, the PPS Coordinator acts as primary resource for immediate problem solving in regards to Functional Independence Measure (FIM) scoring. Corporate Overview: The University of Utah is a Level 1 Trauma Center and is nationally ranked and recognized for our academic research, quality standards and overall patient experience. Our five hospitals and eleven clinics provide excellence in our comprehensive services, medical advancement, and overall patient outcomes.

Requirements

Knowledge of CMS Inpatient Rehabilitation rules and regulations.
Ability to speak, read, write, and communicate effectively.
Ability to coordinate, analyze, observe, make decisions, and meet deadlines in a detail-oriented manner.
Knowledge of ability to learn and perform utilization reviews activities.
Knowledge of or ability to learn and perform insurance carrier/managed care review.
Knowledge and ability to use computers and a variety of computer programs including word processing, database management and spreadsheets.
Demonstrated skills in organization, time management, flexibility, and positive attitude.
Knowledge in ICD-10.
Bachelor's Degree in Health Care Administration, Health Science, a related field, or the equivalency.

Nice To Haves

Current license to practice as a Registered Nurse or Occupational Therapist, Physical Therapist in the State of Utah, or obtain one within 30 days of hire under the interstate compact.
Experience with acute rehab coding, FIM scoring, ICG, CMG.
Clinical Documentation Improvement (CDI) experience.

Responsibilities

Provides concurrent review of medical records to ensure documentation meets quality standards and includes an accurate reflection of the patient's status.
Facilitates modifications to clinical documentation through extensive concurrent interactions with physicians, therapists, nursing staff and coding to support appropriate reimbursement and ensure clinical severity is captured.
Supports timely, accurate, and complete documentation of clinical information used for measuring and reporting provider and hospital outcomes.
Identifies opportunities where additional provider documentation is required to thoroughly and accurately assign Etiological Diagnosis, Impairment Group, CMG and complete IRF-PAI.
Coordinates and performs timely abstraction of required data elements.
Performs data entry and submission of IRF-PAI data to Uniform Data Systems (UDS) and MedTel.
Provides Case Mix Group (CMG) date to rehabilitation staff.
Works collaboratively with providers, nurses, therapists, coding, and CDI staff.
Provides coordination of all clinical documentation for submission to CMS.
Serves as a liaison with contracted data resources.
Ensures adherence to Health Information Coding policies and Official Coding Guidelines as published by CMS and Cooperating Parties, as demonstrated by completion of AHA Coding Clinic quizzes, educational material as assigned, and other in-services scheduled by Coding Leadership.
Oversight of staff education and certification for FIM training.