Rehabilitation Prospective Payment System (PPS) Assistant

GENERAL SUMMARY:

Responsible for assisting with managing and coordinating the payment and reimbursement processes within the inpatient rehabilitation unit. Supports the PPS Specialist to ensure compliance with federal and state regulations, optimizes reimbursement rates, and works closely with interdisciplinary teams to ensure accurate and timely submission of patient assessment data. Plays a role in supporting the financial health of the rehabilitation unit while maintaining high standards of patient care.

PRINCIPAL JOB FUNCTIONS:

1. *Commits to the mission, vision, beliefs and consistently demonstrates our core values.

2. *Assists with the implementation and ongoing management of the Prospective Payment System for inpatient rehabilitation.

3. *Assists with ensuring compliance with Medicare and other regulatory requirements related to PPS, including maintaining current knowledge of all relevant rules and regulations.

4. Collaborate with the interdisciplinary team to accurately capture and document patient data that affects reimbursement rates.

5. *Assists with the completion of patient assessments, such as the Inpatient Rehabilitation Facility Patient Assessment Instrument (IRF-PAI).

6. *Assists with ensuring the timely and accurate submission of all required patient data to meet Medicare deadlines and optimize reimbursement.

7. *Assists with providing education and training to clinical staff on documentation practices and PPS requirements.

8. Assists with collaboration with the billing and coding departments and admitting provider to ensure accurate coding and billing processes.

9. Assists with collaboration with Admissions Specialists to coordinate patient care activities related to reimbursement practices

10. *Assists with conducting regular audits of patient records and PPS documentation to ensure accuracy and compliance.

11. Assists with identifying and implementing process improvements to enhance the efficiency and effectiveness of the PPS program.

12. Stays up-to-date with changes in PPS regulations and provides ongoing education to the rehabilitation team, under the supervision of the PPS Specialist

13. *Completes follow up contact with discharged patients for purposes of data collection regarding potential program improvement

14. Works closely with physicians, therapists, nurses, and other healthcare professionals to ensure that the clinical documentation supports the level of care provided and aligns with PPS requirements.

15. Participates in care planning meetings and provide input on documentation practices and reimbursement considerations.

16. Maintains professional growth and development through seminars, workshops, and professional affiliations to keep abreast of latest trends in field of expertise.

17. Participates in meetings, committees and department projects as assigned.

18. Performs other related projects and duties as assigned.

(Essential Job functions are marked with an asterisk "*". Refer to the Job Description Guide for the definition of essential and non-essential job functions.) Attach Addendum for positions with slightly different roles or work-specific differences as needed.

REQUIRED KNOWLEDGE, SKILLS AND ABILITIES:

1. Knowledge of rehabilitation assessment and CMS admission criteria.

2. Knowledge of IRF-PAI processes.

3. Knowledge of Case Mix Groups (CMG) and Rehabilitation Impairment Categories (RIC).

4. Knowledge of computer hardware equipment and software applications relevant to work functions.

5. Skill in attention to detail and the ability to manage multiple tasks and deadlines.

6. Ability to work in a fast-paced environment related to changing patient needs, including working with patients with acute, chronic and complex disease processes.

7. Ability to lead multi-disciplinary teams work as a team member.

8. Ability to capture and analyze data compared to benchmarks.

9. Ability to communicate effectively both verbally and in writing.

10. Ability to perform crucial conversations with desired outcomes.

11. Ability to establish and maintain effective working relationships with all levels of personnel and medical staff.

12. Ability to problem solve and engage independent critical thinking skills.

13. Ability to maintain confidentiality relevant to sensitive information.

14. Ability to prioritize work demands and work with minimal supervision.

15. Ability to maintain regular and punctual attendance.

EDUCATION AND EXPERIENCE:

Current Registered Nurse licensure from the State of Nebraska or approved compact state of residence as defined by the Nebraska Nurse Practice Act OR Current Physical Therapist licensure from the State of Nebraska OR Current Occupational Therapist licensure from the State of Nebraska OR Current speech language pathologist licensure from the State of Nebraska with current Certificate of Clinical Competence (CCC) from American Speech and Hearing Association (ASHA) required.

Minimum of one (1) year of experience providing direct rehabilitation care or working in a rehabilitation inpatient setting required.

OTHER CREDENTIALS / CERTIFICATIONS:

None