Prospective Payment System Coordinator

University Of Maryland Medical System

Job Location:

Baltimore, MD - USA

Monthly Salary: Not Disclosed

Posted on: 15 hours ago

Vacancies: 1 Vacancy

Job Summary

A Prospective Payment System (PPS) Coordinator is responsible for IRF-PAI and CMS regulatory compliance in accordance with current regulations. Provides expert advice to organization and interdisciplinary rehab team and monitors admissions length of stay and clinical documentation for regulatory compliance.

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 counsel 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.

Qualifications :

Masters degree in physical therapy and current license to practice as a Physical Therapist in the State of Maryland OR Masters degree in Speech Language Pathology and Certification of Clinical Competence OR Bachelors degree in occupational therapy OR certificate from an accredited Occupational Therapy program. Current registration with the American Occupational Therapy Association or Graduation from an accredited school of Nursing and current license to practice as a Registered Nurse in the State of Maryland. BSN 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.
Coursework and experience in research statistics and quality improvement methodology including chart control techniques preferred.

Knowledge Skills & Abilities

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.

Additional Information :

All your information will be kept confidential according to EEO guidelines.

Compensation:
Pay Range: $38.67 - $58.05
Other Compensation (if applicable): n/a
Review the 2025-2026 UMMS Benefits Guide

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Remote Work :

Employment Type :

Full-time

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 counsel 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.

Qualifications :

Masters degree in physical therapy and current license to practice as a Physical Therapist in the State of Maryland OR Masters degree in Speech Language Pathology and Certification of Clinical Competence OR Bachelors degree in occupational therapy OR certificate from an accredited Occupational Therapy program. Current registration with the American Occupational Therapy Association or Graduation from an accredited school of Nursing and current license to practice as a Registered Nurse in the State of Maryland. BSN 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.
Coursework and experience in research statistics and quality improvement methodology including chart control techniques preferred.

Knowledge Skills & Abilities

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.

Additional Information :

All your information will be kept confidential according to EEO guidelines.

Compensation:
Pay Range: $38.67 - $58.05
Other Compensation (if applicable): n/a
Review the 2025-2026 UMMS Benefits Guide

Remote Work :

Employment Type :

Full-time

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University Of Maryland Medical System

When you come to the University of Maryland St. Joseph Medical Center, youre coming to more than simply a beautiful 37-acre, 218-bed suburban Baltimore, Maryland campus. Youre embarking on a professional journey that encourages opportunities, values a team atmosphere, and makes conv ... View more

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