WVU Medicine · 2 weeks ago
Prospective Payment System Coordinator
Morgantown, WV
Full-time
Onsite
Entry, Mid Level
2+ years expWVU Medicine is a healthcare organization that is seeking a Prospective Payment System Coordinator. This role serves as the subject matter expert for the Inpatient Rehabilitation Facility’s Prospective Payment System, ensuring the clinical and regulatory integrity of the IRF-PAI process while driving facility success through documentation auditing and quality improvement strategies.
Health CareHospitalMedical
Responsibilities
Direct the end-to-end IRF-PAI workflow, serving as the final authority on the accuracy and clinical validity of all data transmitted to CMS
Conduct concurrent and retrospective audits of Preadmission Screens (PASE), HPI, and Individualized Plans of Care to ensure they meet the 'Conditions of Participation' and support the medical necessity of 24-hour rehab nursing
Collaborate with physicians, case managers, and HIM coders to validate etiologic diagnoses and co-morbidities, ensuring the assigned Case Mix Group (CMG) accurately reflects the patient’s complexity
Serve as the facility's Subject Matter Expert (SME) on CMS and PPS regulations, proactively identifying changes in federal mandates that impact operations or reimbursement
Design and deliver ongoing training programs for nurses, therapists, and physicians focused on standardized Care Set coding (Section GG) and 'Intensity of Service' documentation
Manage the facility’s credentialing process for GG section scoring, including the initial check-off for new hires and annual re-credentialing for all interdisciplinary staff
Facilitate care conferences to model high-level documentation of interdisciplinary team discussions and ensure the 'patient story' is consistent across all clinical records
Create tools, cheat sheets, and documentation templates that simplify complex CMS requirements for bedside staff
Interpret monthly outcome reports and CMS compliance data to identify performance trends, potential risks, and opportunities for operational growth
Partner with the Rehab Leadership Team to architect and execute Action Plans (PDSA cycles) that target improvements in length of stay, functional gain, and 60% rule compliance
Communicate complex data sets—including regional benchmarking and outcome measures—to stakeholders during program development and rehab operations meetings
Lead the development and modification of internal rehabilitation policies to ensure they align with the latest industry standards and quality benchmarks
Qualification
Required
ADN, Diploma, BSN or higher degree OR equivalent professional degree in Physical Therapy, Occupational Therapy, or Speech Language Pathology
Current Registered Nurse license issued by the state in which services will be provided or current multi-state Registered Nurse license through the enhanced Nurse Licensure Compact (eNLC), OR
Physical Therapist License through West Virginia Board of Physical Therapists OR Physical Therapist Compact License , OR
Occupational Therapist License through West Virginia Board of Occupational Therapy, OR
Licensed Speech Language Pathologist License through the West Virginia Board of Speech-Language Pathology & Audiology
Obtain BLS within 30 days of hire
Two (2) years clinical experience
Effective verbal and written communication skills
Strong interpersonal skills
Strong attention to detail
Knowledge of medical terminology required
Knowledge of third party payers required
Ability to use tact and diplomacy in dealing with others
Working knowledge of computers
Excellent customer service and telephone etiquette
Working knowledge of the Medicare Prospective Payment System
Preferred
Experience with the Inpatient Rehabilitation Facility Patient Assessment Instrument (IRF PAI) and Uniform Data System (UDS)
Company
WVU Medicine
West Virginia University Health System is a non-profit organization that offers a full range of healthcare services.
10001+ employees
Funding
Current Stage
Late StageLeadership Team
Albert L. Wright, Jr.
President and CEO
Zach Kerns
VP of Finance / CFO East Region
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