Job DescriptionIRF-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.
