Prospective Payment System Coordinator

WVU Medicine

About The Position

The PPS Coordinator serves as the subject matter expert and strategic lead for the Inpatient Rehabilitation Facility’s Prospective Payment System. This role is responsible for the clinical and regulatory integrity of the IRF-PAI process, driving facility success through rigorous documentation auditing, interdisciplinary education, and the transformation of data into actionable quality improvement strategies

Requirements

ADN, Diploma, BSN or higher degree OR equivalent professional degree in Physical Therapy, Occupational Therapy, or Speech Language Pathology.
Current license in one of the following: - Current Registered Nurse license issued by the state in which services will be provided or current multi-state Registered Nurse license through the enhanced Nurse Licensure Compact (eNLC), OR - Physical Therapist License through West Virginia Board of Physical Therapists OR Physical Therapist Compact License , OR - Occupational Therapist License through West Virginia Board of Occupational Therapy, OR - Licensed Speech Language Pathologist License through the West Virginia Board of Speech-Language Pathology & Audiology ,
Obtain BLS within 30 days of hire
Two (2) years clinical experience
Effective verbal and written communication skills.
Strong interpersonal skills.
Strong attention to detail.
Knowledge of medical terminology required.
Knowledge of third party payers required.
Ability to use tact and diplomacy in dealing with others.
Working knowledge of computers.
Excellent customer service and telephone etiquette
Working knowledge of the Medicare Prospective Payment System.

Nice To Haves

Experience with the Inpatient Rehabilitation Facility Patient Assessment Instrument (IRF PAI) and Uniform Data System (UDS).

Responsibilities

Direct the end-to-end IRF-PAI workflow, serving as the final authority on the accuracy and clinical validity of all data transmitted to CMS.
Conduct concurrent and retrospective audits of Preadmission Screens (PASE), HPI, and Individualized Plans of Care to ensure they meet the "Conditions of Participation" and support the medical necessity of 24-hour rehab nursing.
Collaborate with physicians, case managers, and HIM coders to validate etiologic diagnoses and co-morbidities, ensuring the assigned Case Mix Group (CMG) accurately reflects the patient’s complexity.
Serve as the facility's Subject Matter Expert (SME) on CMS and PPS regulations, proactively identifying changes in federal mandates that impact operations or reimbursement.
Design and deliver ongoing training programs for nurses, therapists, and physicians focused on standardized Care Set coding (Section GG) and "Intensity of Service" documentation.
Manage the facility’s credentialing process for GG section scoring, including the initial check-off for new hires and annual re-credentialing for all interdisciplinary staff.
Facilitate care conferences to model high-level documentation of interdisciplinary team discussions and ensure the "patient story" is consistent across all clinical records.
Create tools, cheat sheets, and documentation templates that simplify complex CMS requirements for bedside staff.
Interpret monthly outcome reports and CMS compliance data to identify performance trends, potential risks, and opportunities for operational growth.
Partner with the Rehab Leadership Team to architect and execute Action Plans (PDSA cycles) that target improvements in length of stay, functional gain, and 60% rule compliance.
Communicate complex data sets—including regional benchmarking and outcome measures—to stakeholders during program development and rehab operations meetings.
Lead the development and modification of internal rehabilitation policies to ensure they align with the latest industry standards and quality benchmarks.