PPS Coordinator

Major Responsibilities:

• Ensures timely, complete, and accurate encoding and transmission of Medicare Inpatient Rehabilitation Facility Patient Assessment Instrument (IRF-PAI) data to CMS, and submission of outcome data for all non-Medicare patients. Collaborates directly with physicians and other patient care providers to instruct and ensure accurate completion of the IRF-PAI and supporting clinical documentation.
• Responsible for reviewing patients' medical records coding information to ensure accurate information is documented.
• Works closely with leadership on staff/physician education and performance improvement activities to ensure documentation in the medical record is accurate and timely. Develops and implements plans for improvement in the IRF-PAI process in conjunction with site management.
• Reviews and interprets validation reports. Edits and corrects errors on the IRF-PAI and resubmits within the time frames specified by CMS.
• Analyzes and interprets outcome data; collaborates with site leadership to apply data to program evaluation/improvement activities and assure financial viability of the program.
• Collaborates with site and regional leadership to operationalize updates/changes in Medicare laws/regulations related to the IRF-PAI process. Provides education and mentoring to staff/physicians.
• Identifies physician and staff training needs relative to the IRF-PAI process. In collaboration with site and regional leadership, develops and implements educational in-services to meet these needs.
• Implements and ensures completion of the Continuity Assessment Record and Evaluation (CARE) Item Set and provides education as needed.
• May perform monthly data entry audits for quality assurance purposes and takes appropriate actions to ensure the ongoing integrity of data submitted.
• May observe, assess, and/or interview the patient and the patient's family, dialoging with caregivers including the physiatrist, the medical record coder, attending outcome facilitation teams (OFTs), and team conferences. Interprets all patient data to ensure the IRF-PAI is an accurate reflection of the patient's status.
• Must be able to demonstrate knowledge and skills necessary to provide care appropriate to the age of the patients served. Must demonstrate knowledge of the principles of growth and development over the life span and possess the ability to assess data reflective of the patient's status and interpret the appropriate information needed to identify each patient's requirements relative to his/her age-specific needs, and to provide the care needed as described in the department's policies and procedures. Age-specific information is developed further in the departmental job standards.

Licensure, Registration, and/or Certification Required:

• None Required.

Education Required:

• Bachelor's Degree in Nursing, or
• Bachelor's Degree in Occupational Therapy, or
• Bachelor's Degree in Speech Pathology, or
• Bachelor's Degree in Physical Therapy.

Experience Required:

• Typically requires 2 years of experience in an inpatient rehabilitation program.

Knowledge, Skills & Abilities Required:

• Excellent communication and interpersonal skills.
• Basic to intermediate computer skills including experience with electronic mail and electronic medical record systems.

Physical Requirements and Working Conditions:

• Exposed to normal office environment and patient care setting.
• Must have functional speech, vision, and hearing.
• Operates all equipment necessary to perform the job.
• May be exposed to blood and body fluids; therefore must have ability to wear protective clothing as needed.
• Position may require travel; therefore may be exposed to road and weather hazards.

Referral Coordinator

Major Responsibilities: 

• Coordinates rehabilitation therapy for patients discharging from acute care rehabilitation services. 

• Evaluates patients for rehabilitation necessity by reviewing the medical chart and communicating with care providers, physicians, the patient and family. 

• Communicates patient's rehabilitation and other medical needs to care team, ensuring appropriate treatment plan and location preference for the individual. 

• Collects, records and verifies medical, social, demographic and payer data from the hospital record. 

• Actively plans for next level of care with the physician, key staff, patient and family while in the acute care setting. 

• Educates patients, family members, referral sources, hospital staff, external payers, and other external sources as to rehab benefits and services. 

• Works with patient and/or family on assessment for financial coverage or assistance needs and appropriately partners with social work, case management, and/or financial counselor. 

• Collects, collates, reports and provides referral information and relevant patient documents to the recipient site/program. 

• Performs patient assessment on-site or by phone to determine if and when referral is appropriate and would benefit the patient. Consults physicians regarding decisions. Evaluates potential candidates for necessary criteria by evaluation of the medical chart, communication with care providers, physicians and patient/family, and input from other stakeholders. 

• Maintains accurate documentation on admissions, discharges, and referrals. 

• Serves as a consultant with attention to rehab potential, therapy progress, discharge plan feasibility, and special equipment needs. 

• Maintains referral sources by developing and maintaining positive relationships with referring physicians and other referral sources. 

• Provides ongoing monitoring and analysis of trends, issues and data to consistently evaluate service quality, communication systems, and program/referral utilization. 

• Must be able to demonstrate knowledge and skills necessary to provide care appropriate to the age of the patients served. Must demonstrate knowledge of the principles of growth and development over the life span and possess the ability to assess data reflective of the patient's status and interpret the appropriate information needed to identify each patient's requirements relative to his/her age-specific needs, and to provide the care needed as described in the department's policies and procedures. Age-specific information is developed further in the departmental job standards. 

 
Licensure, Registration, and/or Certification Required: 

• Occupational Therapist license issued by the state of Wisconsin, or  

• Physical Therapist license issued by the state of Wisconsin, or  

• Speech-Language Pathology license issued by the state of Wisconsin, or  

• Registered Nurse license issued by the state in which the team member practices. 

 
Education Required: 

• Bachelor's Degree in Occupational Therapy, or  

• Bachelor's Degree in Physical Therapy, or  

• Bachelor's Degree in Speech Pathology, or  

• Associate's Degree in Nursing. 

 
Experience Required: 

• Typically requires 2 years of experience in rehabilitation services.  

 
Knowledge, Skills & Abilities Required: 

• Excellent communication and interpersonal skills along with the ability to effectively interact with a variety of people (physicians, insurance company representatives). 

• Intermediate computer skills using Microsoft office products, electronic mail and electronic medical record systems. 

• Demonstrated ability to work independently in a fast-paced, dynamic environment. 

 
Physical Requirements and Working Conditions: 

• Exposed to normal office environment and occasionally a patient care setting. 

• May be exposed to blood and body fluids; therefore must have ability to wear protective clothing as needed. 

• Must have functional speech, vision, and hearing. 

• Position may require travel; therefore may be exposed to road and weather hazards. 

• Operates all equipment necessary to perform the job. 

This job description indicates the general nature and level of work expected of the incumbent. It is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities required of the incumbent. Incumbent may be required to perform other related duties.