Prospective Payment System Coordinator

University of Maryland Medical System; Baltimore (MD); On-site; USD 70,000 - 95,000; Full time

Job summary

University of Maryland Medical System (UMMS) seeks a PPS Coordinator for the UM Rehabilitation & Orthopaedic Institute to ensure IRF-PAI completion and CMS compliance. You will monitor admissions, length of stay, and clinical documentation with an interdisciplinary team.

You will counsel providers on documentation improvement, update policies per CMS updates, and participate in audits while supporting quality assurance and risk management initiatives.

Qualifications

• Bachelor's degree in physical therapy, occupational therapy, or speech-language pathology is required.
• For nursing candidate: Associate Degree in Nursing; Bachelor of Science preferred.
• Two to three years of inpatient rehabilitation or acute care experience with QA/UR exposure.

Responsibilities

• Completes IRF-PAI per current rules and selects IGC based on physician documentation.
• Collaborates with rehab team to develop comprehensive patient assessments.
• Updates policies and workflows in line with CMS annual updates.
• Counsels physicians and staff on clinical documentation improvement; plans in-service trainings.
• Monitors patient care quality, utilization review and risk management activities.
• Determines appropriateness of admissions, stays, and use of ancillary services.
• Reviews medical records for accuracy and timeliness; supports quality indicators.
• Assists with regulatory audits and CMS surveys as IRF PPS expert.
• Performs other duties as assigned.

Skills

Data analysis

Clinical documentation

CMS regulations

IRF-PAI knowledge

Regulatory compliance

Leadership

Communication

Problem solving

Training coordination

Education

Bachelor's degree in PT/OT/SLP

Nursing associate degree (BS preferred)

Tools

EMR systems

Job description

Job Requirements

About UM Rehab & Ortho Institute With roots dating back to 1895, the UM Rehabilitation & Orthopedic Institute is Maryland's largest provider of inpatient rehabilitation services. Our 141-bed facility serves over 3,000 patients annually, specializing in stroke, spinal cord injury, traumatic brain injury, orthopedic and sports injuries, and more.

Position Overview

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.

Primary Responsibilities

• Completes the Inpatient Rehabilitation Facility-Patient Assessment Instrument (IRF-PAI) in accordance with current rules, regulations and guidelines that govern the assessment. This includes selecting the Impairment Group Code (IGC) based on review and interpretation of physician documentation.
• Works collaboratively with the Interdisciplinary Rehabilitation Team in developing a comprehensive assessment for each patient. Ensures that appropriate health professionals are involved in the assessment and that members of the assessment team are aware of the importance of completeness and accuracy in their assessment functions.
• In accordance with the annual CMS regulatory updates, maintains and updates policies, procedures, and workflows that govern the development, use and implementation of the IRF-PAI in collaboration with the department management. Evaluates and implements recommendations from committees/leadership as they pertain to the patient assessment and/or care plan functions of the unit.
• As IRF PAI PPS Certified expert, counsels physicians and other providers on clinical documentation improvement. Develops, plans, and schedules in-service training classes with other provider educators to include assessment skills or techniques needed to complete the assessment functions of the unit.
• Monitors patient care for quality assurance, utilization review and risk management activities.
• Determines appropriateness and medical necessity of admissions, continued hospital stay, and use of ancillary services. Evaluate the accuracy, completion, and discrepancies of clinical documentation to ensure regulatory compliance.
• Reviews and monitors patient medical records for complete, timely and accurate entries; provides technical assistance to staff regarding developing quality improvement indicators/monitors, measurement methodology and charting technique.
• Facilitates the preparation of and serves as an IRF PPS CMS expert for regulatory audits and compliance surveys.
• Performs all other duties as assigned.

Work Experience

Required Education & Experience

• Bachelor's degree in physical therapy, occupational therapy, or speech-language pathology required.
• For nursing candidate: Associate Degree in Nursing required; Bachelor of Science preferred.
• Two (2) to three (3) years of inpatient rehabilitation or acute care experience including progressively more responsible clinical and/or quality assurance/utilization review experience.

Required Licensure

• Current, active licensure in the State of Maryland as a Physical Therapist (PT), Occupational Therapist (OT), Speech-Language Pathologist (SLP), or Registered Nurse (RN).

Required Skills

• Ability to gather and analyze data/reports, to assess the health status and needs of the patients, to develop/implement programs that support the goals of the patient assessment function, to gather/interpret data and identify discrepancies, problems, or issues, to recommend action plans based on findings, to obtain advice when precedents are unclear or unavailable and to determine methods for ensuring compliance with policies and procedures.
• High level of communication and/or interpersonal skills to relay quality improvement information via complex reports/presentations, and for contacts with physicians, therapists, nursing staff, patients and families to discuss assessment information. Some tact, discretion and conflict resolution skills are exercised. Courtesy and listening skills are required. The ability to read and comprehend procedures and technical literature in specific functional area is necessary.
• Ability to cope with stressful situations or encounters and manage multiple and sometimes conflicting priorities.
• Leadership skills including demonstrated willingness to pursue leadership roles with increasing levels of accountability, comfort with decision-making responsibilities, coaching, teaching and counseling skills, and the ability to inspire and build confidence in others and to forge alliances and garner support.
• Technical knowledge of quality improvement/utilization review procedures and processes, and financial requirements of Medicare, Medicaid, and managed care organizations (including HMOs). Knowledge and skills necessary to prepare written reports regarding analyses and study findings, to prepare and deliver in-service curriculums to varied audiences and to apply legal and regulatory requirements related to quality assurance/utilization review.
• Organizational skills to plan and implement training programs, policies and procedures for the function, etc. and to ensure patient assessments are done completely, accurately and timely.
• Ability to utilize computer systems, computer skills and knowledge of various word processing, spreadsheet, and database software packages.