Rehabilitation Hospital PPS Coord

PPS Coordinator

The purpose of this position is to evaluate and establish the appropriateness of the Admission Impairment Group and Etiologic Diagnosis assignment relative to the existing clinical document within the medical record provided by the healthcare provider. The PPS Coordinator performs clinical review as it pertains to clear and consistent documentation to meet medical necessity guidelines and CMS criteria for Rehabilitation staff and physician documentation. The coordinator will identify potential CMG assignment based on clinical indicators to improve quality of documentation ensuring compliance established by the State and Federal regulations.

This position reports directly to Rehabilitation Hospital Director of Nursing and is also responsible for maintaining relationships with Case Management and the Director of Clinical Documentation Compliance.

This position educates staff and physicians to ensure documentation requirements are met. This position has broad interaction with clinical staff, HIM and the medical staff and has frequent interaction with the Medical Director as it relates to medical staff documentation compliance and physician management of PPS dates. The PPS Coordinator reviews and analyzes IRF-PAI and other health records to identify relevant healthcare information for distinct patient rehabilitation encounter. The PPS coordinator is responsible for translating Rehabilitation Impairment Groups, Etiologic Diagnosis, Comorbid Conditions and Complication phrases utilized by healthcare providers into a coded form. The translation process required interaction with healthcare provider to ensure that terms had been translated correctly. The coded information that is a product of the coding process is then utilized for reimbursement purposes, in the assessment of rehabilitation clinical care, to support medical research activity and to support the identification rehabilitation healthcare concerns critical to the public at large.

The PPS coordinator must have a thorough understanding of the content of the IRF-PAI and medical records in order to be able to locate information to support or provide specificity of tier assignment for CMG and average length of stay (ALOS) This position is challenged to be aware of the continual changes in the Federal and State regulations for prospective payment. Keep informed of changes in treatment plans and complications and perform coding recommendations when physician documentation is vague or missing.

Knowledge, Skills & Abilities

• Excellent written and verbal communication skills.
• Knowledge of Functional Independent Measures (FIM's) and the correlation to patient length of stay (LOS)
• Ability to translate medical data for effective education and communication.
• Knowledge of research basics and the ability to format medical information into a criteria document.
• Ability to assess a situation, consider alternative and take appropriate actions.
• Ability to manage change.
• Excellent organizational and time management skills.

This position does not provide patient care.

The foregoing description is not intended and should not be construed to be an exhaustive list of all responsibilities, skills and efforts or work conditions associated with the job. It is intended to be an accurate reflection of the general nature and level of the job.

Minimum Qualifications:

Requirements - Required and/or Preferred

Education: Must have working-level knowledge of the English language, including reading, writing and speaking English. Bachelor of Nursing Degree preferred.

Experience: Minimum two (2) years of acute care or rehabilitation nursing experience; and prior experience in working with case management and medical staff preferred.

License(s): Ability to obtain and maintain a State of Nevada Registered Nurse license.

Certification(s): None

Computer / Typing: Must possess the computers skills necessary to complete online learning requirements for job-specific competencies, access online forms and policies, complete online benefits enrollment, etc.