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PPS Coordinator Senior

Job Summary

Inpatient Rehabilitation is a post-acute level of care which operates under the Inpatient Rehabilitation Facility Prospective Payment System (IRF PPS). The PPS Coordinator Senior oversees all aspects of data collection for, and timely transmission of the Inpatient Rehab Facility Patient Assessment Instrument (IRF-PAI) in accordance with Centers for Medicare and Medicaid Services. This individual utilizes specialty knowledge of IRF Medicare rules and regulations to support compliant billing for all cases discharged from the 40 bed, U-M Health joint venture inpatient rehabilitation unit at Chelsea Hospital. This expertise is also utilized to educate faculty and staff, ensure facility compliance with regulatory standards, maximize reimbursement and contribute to quality initiatives especially related to clinical documentation. Compilation and analysis of data to inform and support programmatic quality and improvement initiatives is a large component of this position. The PPS Coordinator Senior collaborates with Medical Coding to ensure congruency with rehab coding guidelines and to align the IRF-PAI with the UB-04 claim for proper payment.

This position reports to the IPR Administrative Operations Manager.

Responsibilities*

Functional Supervision

+ Oversees PPS Coordinator in completing IRF-PAI. Monitors and audits work queues for completion efficiency and accuracy.

+ May carry a partial to full PPS caseload at times and serve as back-up for PPS Coordinator role

IRF-PAI Data Management

+ Completes Inpatient Rehabilitation Facility Patient Assessment Instrument (IRF-PAI) for each patient admitted and discharged. Requires coding in accordance with the CMS IRF-PAI

+ Coding manual as well as facility specific guidelines. Ensures data transcription accuracy and presence of supporting documentation in the medical record from physician and clinical staff.

+ Responsible for accuracy of IRF-PAI ICD-10-CM coding: assigns all Rehabilitation Impairment Group Categories (IGCs), reviews and modifies etiologic diagnoses and comorbid conditions as needed

+ Performs timely documentation queries with the physician, clinical staff and HIM necessary to maximize reimbursement, ensure IRF QRP (Quality Reporting Program) compliance and accuracy, as well as 60% compliance.

+ Adheres to internal workflow timing guidelines as it relates to admission and discharge coding. Submits IRF-PAI to CMS in accordance with both internal timing guidelines and CMS expectations.

+ Provides CMG length of stay (LOS) guidelines for team meetings based on clinical data to support appropriate bed utilization and minimize audit risk for LOS outliers.

+ Maintains updated and ongoing knowledge of federal regulations concerning the IRF PPS and IRF-PAI to ensure compliance and proper billing. This includes participating in the operationalization of annual IRF-PAI updates and CMS Quarterly clarifications.

+ Maintains IRF-PAI Workflow process document through quarterly review and updates

IRF Prospective Payment System (PPS) Responsibilities

+ Tracks compliance with 60% rule and provides analysis and identification of factors impacting compliant diagnoses

+ Completes routine accuracy and quality audits to ensure complete and accurate IRF-PAI data that is supported by clinical documentation.

+ Leads efforts to streamline data abstraction process related to completion of the IRF-PAI including working toward interface between EMR and inpatient rehab facility outcomes system.

+ Works with Epic to address changes/updates necessary to maintain alignment with IRF reporting and documentation requirements.

+ Develops and assists with implementation of process-improvement and risk mitigation projects and initiatives to ensure compliance with current CMS regulations.

+ Informs rehab leadership team on policy, procedure, and regulatory adherence through monitoring of documentation and reports

+ Collaborates for appropriateness of currently established operational policies and procedures

Faculty/Staff Education

+ Delivers and oversees delivery of IRF PPS education including Section GG, Medicare guidelines, and documentation requirements to Clinical Team and reports on adherence and issues to rehab management team

Data Management

+ Administrator and subject matter expert for UDS

+ CMS iQIES security administrator for overseeing IRF-PAI submission activity, monitoring QRP compliance and managing user roles

+ Maintains IRF operational metrics and provides monthly and annual status reports to IRF administrative and clinical leaders.

+ Provides ad hoc metrics to support and inform IRF operations and business strategy.

Required Qualifications*

+ Minimum of a bachelor's degree in a recognized field which is directly related to the duties of the position

+ Previous experience as a PPS Coordinator

+ Experience working navigating an electronic medical record (Epic preferred) including efficient review of clinical documentation

+ Detail-oriented with strong organizational, analytical, and problem-solving skills

+ Proficiency in database and spreadsheet creation and analysis, (Excel) and presentation software

+ Must be detail oriented with strong analytic and problem-solving skills, exceptional communication skills (both verbal and written) as well as exceptional presentation skills

Senior:

+ Minimum of 3 years of experience in the analysis, interpretation, and management of patient-related health care data

+ At least 5 years of experience in analyzing and interpreting process, clinical outcomes and costs of care

Intermediate:

+ Minimum of 2 years of experience or knowledge in the delivery of patient care needed to perform the duties of the position

+ At least 3 years of experience in analyzing and interpreting process, clinical outcomes and costs of care

Desired Qualifications*

+ Clinical background or experience in medical coding, hospital billing, or utilization review preferred

+ Medical chart auditing experience preferred

Work Schedule

Flexible hours available between 6AM-5PM Monday-Friday. Hybrid with onsite work at University of Michigan Hospital and Chelsea Hospital.

Modes of Work

Positions that are eligible for hybrid or mobile/remote work mode are at the discretion of the hiring department. Work agreements are reviewed annually at a minimum and are subject to change at any time, and for any reason, throughout the course of employment. Learn more about thework modes (https://hr.umich.edu/working-u-m/my-employment/ways-we-work-resource-center/ways-we-work-implementation-group/modes-work) .

+ This is a hybrid position but may consider fully remote.

Underfill Statement

This position may be underfilled at a lower classification depending on the qualifications of the selected candidate.

Background Screening

Michigan Medicine conducts background screening and pre-employment drug testing on job candidates upon acceptance of a contingent job offer and may use a third party administrator to conduct background screenings. Background screenings are performed in compliance with the Fair Credit Report Act. Pre-employment drug testing applies to all selected candidates, including new or additional faculty and staff appointments, as well as transfers from other U-M campuses.

Application Deadline

Job openings are posted for a minimum of seven calendar days. The review and selection process may begin as early as the eighth day after posting. This opening may be removed from posting boards and filled anytime after the minimum posting period has ended.

U-M EEO Statement

The University of Michigan is an equal employment opportunity employer.

Job Detail

Job Opening ID

263931

Working Title

PPS Coordinator Senior

Job Title

Clinical Info Analyst Sr

Work Location

Michigan Medicine - Ann Arbor

Ann Arbor, MI

Modes of Work

Hybrid

Full/Part Time

Full-Time

Regular/Temporary

Regular

FLSA Status

Exempt

Organizational Group

Um Hospital

Department

MM PM&R Chelsea MSA Admin

Posting Begin/End Date

5/21/2025 - 6/04/2025

Career Interest

Healthcare Admin & Support