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Department: Comprehensive Rehab Ctr - CPRH
Usual Schedule: 8a-4:30p
Regions: Carle Foundation
On Call Requirements: N/A
Job Category: Nursing
Work Location: Proctor Hospital
Employment Type: Part - Time
Nursing Specialty:
Job Post ID: 46192
Secondary Job Category:
Experience Requirements: 1 - 3 Years
Weekend Requirements: Rotating
Education Requirements: Technical/Vocational degree
Shift: Day
Location: Peoria, IL
Holiday Requirements: Varies
Check out this job opening for Carle Providers: PPS Coordinator- Comprehensive Rehab Check out this job opening for Carle Providers: PPS Coordinator- Comprehensive Rehab


Job Description

JOB SUMMARY:
The PPS Coordinator is responsible for making sure the IRF-PAI is completed utilizing input from all disciplines. Responsible for managing reimbursement from Medicare and Managed Care companies. Provides training, education and communication to team members, medical providers, and various departments, which include Coding and Billing departments on reimbursement and PPS updates or changes. Mentors the team members, medical providers, and various departments, including Coding and Billing departments to guide for success. Responsible for ensuring processes and procedures are followed within the department.

EDUCATIONAL REQUIREMENTS
College Diploma in Practical Nursing or Certificate in Practical Nursing

CERTIFICATION & LICENSURE REQUIREMENTS
Licensed Practical Nurse (LPN) Illinois upon hire 

ADDITIONAL REQUIREMENTS
 1-3 years of clinical bedside experience
Rehab experience is highly preferred but not required
   
SKILLS AND KNOWLEDGE
Writes, reads, comprehends, and speaks fluent English.Basic computer knowledge using word processing, spreadsheet, email, and web browser. Multicultural sensitivityAdvanced reading, writing and oral skillsAbility to respond appropriately to customer/coworkerInteraction with a wide variety of peopleMaintain confidential informationAbility to communicate only the facts to recipients or to decline to reveal informationAbility to project a professional, friendly, helpful demeanorAbility to utilize PC including, basic elements of Windows environment, keyboarding, work with mouse, and perform basic computer tasks with instruction.Critical thinking skills using independent judgment in making decisions.

ESSENTIAL FUNCTIONS:
  • Coordinates the completion of the IRF-PAI for each patient per state/federal guidelines to be used for the Medicare reimbursement system and quality reporting.
  • Regulates the PPS completion schedule of assessments per CMS for appropriate reimbursement.
  • Patient's Care Tool is thoroughly reviewed for accuracy. Documentation of care given is evidenced on appropriate forms.
  • Maintains current with changes to Prospective Payment System (PPS) reimbursement.
  • Provides training, education and communication to team members, medical providers, and various departments, which include Coding and Billing departments on reimbursement and PPS updates or changes.
  • Notifies appropriate staff of any discrepancies with admission or discharge documentation and requirements.
  • Overseas all CMS IRF Quality Measures & Quality Reporting Program. Notifies appropriate staff regarding any discrepancies and corrects information as needed.
  • Ensures all team members, including various departments are following the IRF procedures and regulations to remain in compliance with governing bodies.
  • Reviews IRF EMR documentation for accuracy and completes the IRF-PAI per CMS regulations.
  • Completes weekly transmission of IRF-PAIs to CMS per guidelines.
  • Enters CMGs into the Rehab WQ in EMR following weekly transmission to CMS.
  • Responsible for monitoring IRF work que timely and efficiently.
  • Completes weekly Team Conference report for the IDT.
  • Determine process changes/education need from information provided by Patient Financial Services (billing denials, down coding, outlier payments, etc.).
  • Notify IRF Leadership Team of any denials, trends. Manage any IRF denials and/or information requests.
  • Accumulate data for finance department to be used to assess operations. Answer finance question in a timely, appropriate manner.
  • Manages UDS IRF software for documentation entry and electronic transmission.
  • Reviews charts for Quality Assurance information and discrepancies, reporting to Rehab leadership, as needed.
  • Initiates measures to improve patient outcomes. Works with team members for proper utilization of resources.
  • Assists in identifying ways to improve patient outcomes. Identify deficiencies in care and report to leadership, as appropriate.
  • Maintain all Illinois Dept. of Public Health (IDPH), Centers for Medicare & Medicaid Services (CMS) and Joint Commission standards. Ensures others are following appropriate procedures to remain in compliance with State and Federal agencies.



APPLY NOW

All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran. We are committed to creating a diverse and welcoming workplace that includes partners with diverse backgrounds and experiences. We believe that enables us to better meet our mission and values while serving customers throughout our communities. People of color, women, LGBTQIA+, veterans and persons with disabilities are encouraged to apply. Qualified applicants with criminal histories will be considered for employment in a manner consistent with all federal state and local ordinances. Carle Health participates in E-Verify and may provide the Social Security Administration and, if necessary, the Department of Homeland Security with information from each new employee's Form I-9 to confirm work authorization. | For more information: human.resources@carle.com. Positions are not available for remote work in the state of Colorado.

Effective September 20, 2021, the COVID 19 vaccine is required for all new Carle Health team members. Requests for Medical or Religious exemption will be permitted.

 

Illinois Required Notices

Federal Required Notices