Prospective Payment System Coordinator ( PPS COORDINATOR )

Horizon Rehabilitation Hospital • McKinney, TX

3d • 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 Full time PPS Coordinator to join our team. This a Monday-Friday 8am to 5pm position. 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

• Minimum 1 year recent clinical experience in inpatient rehabilitation.
• Ability to project a professional image.
• Knowledge of regulatory standards and compliance requirements.
• Strong organizational, prioritizing and analytical skills.
• Ability to make independent decisions when circumstances warrant.
• Working knowledge of computer and software applications used in job functions.
• Freedom from illegal use of and effects of use of drugs and alcohol in the workplace.
• A licensed or certified clinician who holds a current, valid, and active state license to practice as a healthcare professional.
• Regular and punctual attendance.
• English is the primary language of the facility.
• Ability to read and write, communicate clearly with co- workers and customers and to respond to appropriate questions regarding work process or work product.
• Ability to add, subtract, multiply, and divide in all units of measure, using whole numbers, common fractions, and decimals.
• Ability to compute rate, ratio, and percent.
• Ability to apply common sense understanding to carry out instruction furnished in written, oral and/or diagram form.
• Ability to define and solve problems and collect data.

Nice To Haves

• Bachelor’s degree preferred.
• 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

• 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.
• Integrating 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.
• Serving 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