Prospective Payment System (PPS) Coordinator at WVU Medicine: A Comprehensive Overview

WVU Medicine is seeking a highly skilled and dedicated Prospective Payment System (PPS) Coordinator to join our team at Ruby Memorial Hospital in Morgantown, West Virginia. This critical role serves as the subject matter expert and strategic lead for the Inpatient Rehabilitation Facility’s Prospective Payment System (IRF PPS). The PPS Coordinator ensures the clinical and regulatory integrity of the IRF-PAI process, driving facility success through meticulous documentation auditing, comprehensive interdisciplinary education, and the transformation of data into actionable quality improvement strategies.

Role Overview

The Prospective Payment System (PPS) Coordinator is responsible for the complete oversight of the IRF-PAI process within the Inpatient Rehabilitation Facility. This includes ensuring compliance with all CMS regulations, maintaining accurate and complete clinical documentation, and providing education and training to the interdisciplinary team. The Coordinator acts as the final authority on the accuracy and clinical validity of all data submitted to CMS. This pivotal position directly impacts the facility's reimbursement and overall quality of care.

A Day in the Life of a PPS Coordinator

A typical day for a PPS Coordinator at WVU Medicine might involve the following activities:

• Morning: Reviewing newly admitted patients' preadmission screens (PASE) and initial evaluations to ensure appropriate medical necessity for inpatient rehabilitation.
• Mid-day: Conducting concurrent audits of patient charts to verify documentation supports the assigned Case Mix Group (CMG) and accurately reflects the patient's condition and treatment plan.
• Afternoon: Facilitating a care conference with the interdisciplinary team to discuss a complex patient case, ensuring consistent documentation across all disciplines.
• Late Afternoon: Developing and delivering a training session on standardized Care Set coding (Section GG) for new nursing staff.
• End of Day: Monitoring CMS updates and regulations to identify any changes that may impact the facility's IRF-PAI process.

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, diverse dining options, and a thriving job market. The city is surrounded by scenic mountains and offers abundant opportunities for outdoor recreation, including hiking, biking, and water sports. With affordable housing and a low cost of living, Morgantown is an excellent place to live, work, and raise a family.

Career Path

The PPS Coordinator role offers opportunities for professional growth and advancement within WVU Medicine. With experience and expertise, the Coordinator may progress to roles such as:

• Rehabilitation Manager: Overseeing the operations of the Inpatient Rehabilitation Facility.
• Quality Improvement Specialist: Leading quality improvement initiatives across multiple departments.
• Compliance Officer: Ensuring compliance with all applicable regulations and policies.
• Clinical Documentation Improvement (CDI) Specialist: Focusing on improving the quality and accuracy of clinical documentation throughout the organization.

Salary & Benefits

The estimated salary range for a PPS Coordinator at WVU Medicine is $70,000 to $95,000 per year, commensurate with experience and qualifications. WVU Medicine offers a comprehensive benefits package, including:

• Comprehensive health insurance (medical, dental, vision)
• Paid time off (PTO) and holidays
• Retirement plan with employer matching
• Life insurance
• Disability insurance
• Flexible spending accounts (FSA)
• Employee assistance program (EAP)
• Wellness programs
• Tuition reimbursement
• Professional development opportunities
• Employee discounts

WVU Medicine Culture

WVU Medicine is committed to providing exceptional patient care in a supportive and collaborative environment. We value teamwork, respect, and continuous learning. Our employees are our greatest asset, and we strive to create a workplace where everyone feels valued, respected, and empowered to reach their full potential. We believe in fostering a culture of innovation and continuous improvement, where employees are encouraged to share their ideas and contribute to the success of the organization.

How to Apply

Interested candidates are encouraged to apply online through the WVU Medicine Careers website. Please submit a resume and cover letter highlighting your qualifications and experience. Be sure to emphasize your knowledge of IRF-PAI, CMS regulations, and clinical documentation practices.

Frequently Asked Questions (FAQ)

1. What is the IRF-PAI?

   The Inpatient Rehabilitation Facility Patient Assessment Instrument (IRF-PAI) is a standardized data collection tool used to assess the characteristics and outcomes of patients receiving inpatient rehabilitation services. It is required by CMS for all IRFs participating in the Medicare program.

2. What is the Uniform Data System (UDS)?

   The Uniform Data System for Medical Rehabilitation (UDSMR) is a non-profit organization that maintains a database of rehabilitation patient outcomes. UDSMR provides standardized reports and benchmarks that help IRFs improve their performance.

3. What are the key responsibilities of a PPS Coordinator?

   The PPS Coordinator is responsible for ensuring the accuracy and completeness of IRF-PAI data, providing education and training to the interdisciplinary team, and monitoring compliance with CMS regulations.

4. What qualifications are required for this position?

   The position requires a degree in nursing, physical therapy, occupational therapy, or speech-language pathology, along with relevant licensure and experience in inpatient rehabilitation.

5. What skills are essential for success in this role?

   Key skills include knowledge of IRF-PAI, CMS regulations, clinical documentation practices, and strong communication and interpersonal skills.

6. What opportunities are there for professional development?

   WVU Medicine offers a variety of professional development opportunities, including tuition reimbursement, continuing education courses, and leadership training programs.

7. What is the work environment like at WVU Medicine?

   WVU Medicine is committed to providing a supportive and collaborative work environment where employees feel valued and respected.

8. What are the benefits of working at WVU Medicine?

   WVU Medicine offers a comprehensive benefits package, including health insurance, paid time off, retirement plan, and tuition reimbursement.

9. How does the PPS Coordinator contribute to patient care?

   By ensuring accurate and complete IRF-PAI data, the PPS Coordinator helps to optimize reimbursement for the facility and ensures that patients receive the appropriate level of care.

10. What is the most challenging aspect of this role?

    Staying current with the ever-changing CMS regulations and ensuring compliance across the interdisciplinary team can be challenging but also rewarding.