Prospective Payment System Coordinator

University of Maryland Medical System•Baltimore, MD

15d

About The Position

The PPS Coordinator is responsible for IRF-PAI completion and CMS regulatory compliance. This role serves as an expert resource to the organization and interdisciplinary rehab team, monitoring admissions, length of stay, and clinical documentation to ensure compliance with current regulations.

Requirements

Master's degree in Physical Therapy with current Maryland Physical Therapist license
Master's degree in Speech Language Pathology with Certificate of Clinical Competence
Bachelor's degree or certificate from an accredited Occupational Therapy program with current AOTA registration
Graduation from an accredited Nursing program with current Maryland RN license (BSN preferred)
2–3 years of inpatient rehabilitation or acute care experience, with progressively responsible clinical and/or quality assurance/utilization review experience
Strong analytical skills with the ability to gather, interpret, and act on data; identify discrepancies; and recommend solutions that ensure regulatory compliance
High level of communication and interpersonal skills, including the ability to present complex quality improvement information to physicians, clinical staff, patients, and families with tact and discretion
Technical knowledge of quality improvement and utilization review processes, as well as Medicare, Medicaid, and managed care financial requirements
Demonstrated leadership skills including decision-making, coaching, teaching, and the ability to build confidence and collaboration across teams
Strong organizational skills with the ability to manage multiple priorities, implement training programs, and ensure assessments are completed accurately and on time
Proficiency in computer systems including word processing, spreadsheet, and database software

Nice To Haves

Coursework and experience in research statistics and quality improvement methodology, including chart control techniques

Responsibilities

Complete the IRF-PAI in accordance with CMS rules and regulations, including selecting the appropriate Impairment Group Code (IGC) based on physician documentation
Collaborate with the Interdisciplinary Rehabilitation Team to develop comprehensive patient assessments, ensuring accuracy and completeness
Maintain and update IRF-PAI policies, procedures, and workflows in accordance with annual CMS regulatory updates
Counsel physicians and providers on clinical documentation improvement and conduct in-service training as needed
Monitor patient care for quality assurance, utilization review, and risk management
Evaluate medical necessity for admissions, continued stays, and ancillary services
Serve as the IRF PPS CMS expert during regulatory audits and compliance surveys