Prospective Payment System (PPS) Coordinator - Clinical Specialist at WVU Medicine

Role Overview

The Prospective Payment System (PPS) Coordinator - Clinical Specialist at WVU Medicine's Ruby Memorial Hospital plays a vital role in ensuring the clinical and regulatory integrity of the Inpatient Rehabilitation Facility's (IRF) Prospective Payment System. This position requires a highly skilled and knowledgeable professional who can serve as a subject matter expert, strategic lead, and educational resource for the interdisciplinary team. The PPS Coordinator is responsible for driving facility success through rigorous documentation auditing, providing comprehensive interdisciplinary education, and transforming data into actionable quality improvement strategies. This role demands a deep understanding of CMS regulations, clinical coding practices, and the IRF-PAI process. The ideal candidate will possess a strong clinical background, excellent communication skills, and a passion for improving patient outcomes.

A Day in the Life

Imagine starting your day by reviewing the latest CMS updates to identify any changes that may impact the IRF's operations or reimbursement. You then conduct concurrent audits of patient charts to ensure compliance with documentation requirements and support the medical necessity of 24-hour rehab nursing. Next, you collaborate with physicians, case managers, and HIM coders to validate etiologic diagnoses and co-morbidities, ensuring accurate assignment of Case Mix Groups (CMGs). In the afternoon, you lead an educational session for nurses and therapists on standardized Care Set coding (Section GG), focusing on intensity of service documentation. You also manage the facility's credentialing process for GG section scoring, ensuring that all interdisciplinary staff are properly trained and competent. Finally, you analyze data to identify trends and opportunities for quality improvement, presenting your findings to the leadership team.

Why Morgantown, West Virginia?

Morgantown, West Virginia, offers a unique blend of small-town charm and big-city amenities. Home to West Virginia University, Morgantown boasts a vibrant cultural scene, with numerous restaurants, shops, and entertainment options. The city is surrounded by beautiful natural landscapes, providing ample opportunities for outdoor recreation, including hiking, biking, and fishing. Morgantown also offers a low cost of living compared to many other cities in the United States, making it an attractive place to live and work. Additionally, WVU Medicine is a major employer in the region, providing stability and career growth opportunities.

Career Path

This position offers a clear path for career advancement within WVU Medicine. With experience and demonstrated success, the PPS Coordinator - Clinical Specialist can advance to roles such as: * Senior PPS Coordinator: Overseeing multiple IRF units or facilities. * Clinical Manager: Leading a team of clinical specialists and coordinators. * Director of Rehabilitation Services: Providing strategic leadership for all rehabilitation services within the organization. * Compliance Officer: Focusing on regulatory compliance and risk management. WVU Medicine is committed to providing its employees with opportunities for professional development and growth, ensuring a rewarding and fulfilling career.

Salary & Benefits

The estimated salary range for the PPS Coordinator - Clinical Specialist position at WVU Medicine is $75,000 to $110,000 per year, commensurate with experience and qualifications. In addition to a competitive salary, WVU Medicine offers a comprehensive benefits package, including: * Comprehensive health insurance (medical, dental, vision) * Paid time off (PTO) and holidays * Retirement plan with employer match * Life insurance and disability insurance * Professional development opportunities and tuition reimbursement * Employee assistance program (EAP) and wellness programs * Flexible spending accounts (FSA) and dependent care assistance program (DCAP) * Employee discounts and other perks

WVU Medicine Culture

WVU Medicine is committed to creating a culture of teamwork, respect, and patient-centered care. Employees are valued for their contributions and encouraged to participate in continuous improvement initiatives. The organization fosters a supportive and collaborative work environment, where employees can learn and grow. WVU Medicine also places a strong emphasis on employee well-being, offering a variety of programs and resources to support physical, mental, and emotional health. Joining WVU Medicine means becoming part of a team that is dedicated to providing the highest quality care to the communities it serves.

How to Apply

To apply for the PPS Coordinator - Clinical Specialist position at WVU Medicine, please visit the WVU Medicine careers website and search for the job posting. Follow the instructions to complete the online application and submit your resume and cover letter. Be sure to highlight your relevant experience and qualifications, including your knowledge of IRF-PAI, PPS, and CMS regulations. WVU Medicine is an equal opportunity employer and welcomes applications from all qualified individuals.

Frequently Asked Questions (FAQ)

**Q1: What are the key responsibilities of a PPS Coordinator - Clinical Specialist?** A1: The PPS Coordinator is responsible for the clinical and regulatory integrity of the IRF-PAI process, driving facility success through rigorous documentation auditing, interdisciplinary education, and the transformation of data into actionable quality improvement strategies. **Q2: What qualifications are required for this position?** A2: The minimum qualifications include an ADN, Diploma, BSN or higher degree (or equivalent in Physical Therapy, Occupational Therapy, or Speech Language Pathology), a current license as a Registered Nurse, Physical Therapist, Occupational Therapist, or Speech Language Pathologist, and BLS certification within 30 days of hire. **Q3: What experience is preferred for this role?** A3: Experience with the Inpatient Rehabilitation Facility Patient Assessment Instrument (IRF PAI) and Uniform Data System (UDS) is highly preferred. **Q4: What is the work environment like at WVU Medicine?** A4: WVU Medicine fosters a supportive and collaborative work environment, where employees can learn and grow. The organization is committed to teamwork, respect, and patient-centered care. **Q5: What are the opportunities for career advancement at WVU Medicine?** A5: WVU Medicine offers numerous opportunities for career advancement, including roles such as Senior PPS Coordinator, Clinical Manager, Director of Rehabilitation Services, and Compliance Officer. **Q6: What kind of training and development opportunities are available?** A6: WVU Medicine provides ongoing training programs for nurses, therapists, and physicians focused on standardized Care Set coding and intensity of service documentation. They also offer tuition reimbursement and professional development opportunities. **Q7: What is the salary range for this position?** A7: The estimated salary range for the PPS Coordinator - Clinical Specialist position is $75,000 to $110,000 per year, commensurate with experience and qualifications. **Q8: What benefits are offered by WVU Medicine?** A8: WVU Medicine offers a comprehensive benefits package, including health insurance, paid time off, retirement plan with employer match, life insurance, disability insurance, and more. **Q9: How does WVU Medicine support employee well-being?** A9: WVU Medicine places a strong emphasis on employee well-being, offering a variety of programs and resources to support physical, mental, and emotional health, including an employee assistance program and wellness programs. **Q10: Is WVU Medicine an equal opportunity employer?** A10: Yes, WVU Medicine is an equal opportunity employer and welcomes applications from all qualified individuals.