PPS (PROSPECTIVE PAYMENT SYSTEM) COORD / ADMISSIONS COORD - ACUTE REHAB

• Position summary:

The PPS Coordinator/Admissions Coordinator oversees the coordination of all clinical documentation required for completion of the Inpatient Rehabilitation Facility Patient Assessment Instrument (IRF-PAI), and provides oversight regarding the length of stay in collaboration with the clinical team. Conducts ongoing review of the CMS data submitted and the patient’s medical record to assure that the documentation is accurate and that the data is congruent. Supervises/coordinates IDT meetings with physicians, nursing, therapy, and social work. They facilitates a timely, accurate and otherwise effective referral intake as outlined in the admission workflow process. Provides analytical insight into the admissions data and referral patterns for effective and sustained business development.  The incumbent coordinates activities with other departments as needed and participates in other related organizational activities.  The incumbent oversees the pull-through process for the hospital under the direction of the manager, providing support, customer service and timely resolution of all aspects for admissions.

• igned

• Education:
  • Registered Nurse currently licensed in the State of Ohio. Bachelor's Degree preferred.       PT, OT, or ST licensed by the State of Ohio.
• 
  Required length and type of experience:
  • Minimum of two years experience required with post acute care rehabilitation experience preferred. Previous experience with rehab/post acute admissions and case management preferred.
• 
  Required licensure, certification or registry:
  • Registered Nurse currently licensed in the State of Ohio.
  • PT, OT, or ST licensed by the State of Ohio.

• Below are the duties and responsibilities for this position.
  • Reviews all documentation for submission to the Centers for Medicare and Medicaid Services (CMS), confers with the clinical team, and directs the correction of documentation on the IRF-PAI when indicated.
  • Assesses clinical documentation for missing or errant entries and notifies clinical leadership or clinicians for corrections or addendums.
  • Assures timely submission of all IRF-PAI records to CMS, and coordinates the timely correction of IRF-PAI corrections.
  • Confers with the Medical Records Manager to assure proper coding according to coding conventions on audits as needed.
  • Provides feedback to the clinical manager regarding the patients currently in hours and their status with regard to the targeted length of stay.
  • Works closely with departments Assistant Clinical Manager to focus on documentation trends and corrective action to assure that the medical record documentation supports the IRF-PAI documentation.
  • Confers with the patient and clinical team members regarding the scoring of quality indicators, follows up on any inconsistencies, and, when necessary, assesses the patient to confirm correct score.
  • Reviews all Rehabilitation Impairment Categories and admission ICD-10 codes to assure congruence and proper coding for the IRF-PAI. Makes any necessary changes in collaboration with the clinical team and physician.
  • Performs other duties as assigned.
  • Ensures that all deficiencies remain at 0% to eliminate holds, working with others to ensure any errors are resolved
  • Ensures every referral is timely and accurately entered in Transitions of Care
  • Processes timely insurance verifications
  • Assists in pre-cert/authorization process – tracks for follow up and timely processing
  • Works with manager and other leaders to ensure timely admissions from time of referral
  • Works with team to resolve occasional challenges and overcome obstacles
  • Enters patient data when pre-admitting, and enters details of patient’s benefits and billing instructions
  • Completes admissions paperwork and reviews all patient forms/demographics with patient/responsible party
  • Secures signatures on all necessary documents