Rehab PPS & Quality Coordinator

IRF-PAI Management: 

• Complete, encode, and submit IRF-PAI assessments and CMS Quality Indicators (e.g., Section GG) within required timeframes. 
• Collect, enter, analyze, and transmit clinical data in compliance with Medicare PPS requirements. 
• Ensure accuracy and completeness of all data submitted for CMS reimbursement. 
• Maintain current knowledge of IRF-PAI data definitions, coding rules, and submission guidelines.

Quality and Safety Measurement

• Support abstraction, analysis, and reporting of clinical quality measures for internal and external programs. 
• Monitor performance metrics and identify trends in quality and patient outcomes. 
• Conduct data audits to ensure accuracy, completeness, and regulatory compliance. 
• Assist with quality improvement initiatives and reporting requirements.

Chart & Coding Review: 

 Perform concurrent medical record reviews to assign appropriate Impairment Group Codes (IGC), etiologic diagnoses, and comorbidities. 

 Collaborate with coding and revenue cycle teams to ensure accurate reimbursement. 

 Monitor documentation to support coding accuracy and regulatory compliance.

Interdisciplinary Collaboration: 

• Partners with physicians, therapists, nursing, and case management to ensure documentation reflects patient severity and care needs. 
• Participate in interdisciplinary rounds and team conferences to support care planning and length-of-stay (LOS) management. 
• Assist with patient screening for rehabilitation appropriateness. 
• Provide backup support for admissions coordination as needed.

Audit & Compliance: 

• Monitor key IRF metrics (e.g., LOS, Case Mix Index, ADC, CMGs). 
• Ensure compliance with CMS requirements, including the 60% rule, 3-hour rule, and documentation standards. 
• Prepare for audits, medical reviews, and Additional Documentation Requests (ADRs). 
• Support Utilization Review processes and regulatory survey readiness. 
• Track regulatory updates and ensure adherence to current standards.

Education & Training: 

• Educate clinical staff on CMS documentation requirements, IRF-PAI scoring, and PPS guidelines. 
• Provide ongoing training on quality measures and rehabilitation program metrics. 
• Support staff competency in regulatory and documentation standards. 
• Maintain required continuing education and professional development.

Additional Duties

• Perform other duties as assigned to support departmental and organizational goals.

QUALIFICATIONS/REQUIREMENTS:  

Clinical License/Training:

• Requires an active state license as a Registered Nurse (RN), Physical Therapist (PT), Occupational Therapist (OT), Speech-Language Pathologist (SLP), or Medical Social Worker (LMSW).
• UDS training & certifications in PPS required within 1 year of hire

Experience:

• Minimum of 5 years of clinical experience in an inpatient rehabilitation setting.
• Deep understanding of CMS IRF guidelines, Medicare billing, and proficiency with specialized software (e.g., UDS-Pro/UDSmr).

Skills:

• Strong analytical abilities, attention to detail, and excellent communication skills.
• Demonstrates professional work behavior
• Complies with departmental organizational policies and procedures and adheres to external agency/ regulatory requirements.
• Proficient in word, excel, MS Teams, outlook
• Understanding of EPIC EMR preferred.