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PPS/Quality Coordinator

Macon, GA, United States
Job ID: 33896
Job Family: Nursing
Specialty: Physical Medicine and Rehabilitation
Status: Full Time
Shift: Day
Shift Details: Regular
Department Name: 45531053540501-Administration
Location: 0230


PPS/Quality Coordinator

To maximize reimbursement according to Medicare Guidelines and comply with all regulations for rehab. Responsible for researching all referral/new admission paperwork for rehab diagnoses and pertinent co-morbidities.   Also collaborates with clinical liaisons, attending physicians, Director of Patient Care Services and clinical staff, to confirm the rehab diagnoses and co-morbidities and completing IRF-PAIs while assigning correct CMG codes. Collaborates to ensure maximization of reimbursement with inpatient and outpatient billing and business offices.   Collaborates with HIMS to ensure compliance standards are met.  Responsible for coordinating all Medicare and non-Medicare appeals responses.  Acts as the Accreditation officer for the hospital for State, Joint Commission, and CMS surveys.   Provides clinical expertise, supervisory leadership, and monitoring of nursing practice.  Scope of position includes, Performance Improvement, patient satisfaction, program development for nursing/clinical practice and patient outcomes.  Collaboration of these areas to ensure successful integration of delivery of patient care.  Administratively responsible for the hospital wide functions of Risk Management, Compliance, Lean program facilitation, Wound Care, Education Department, Employee Health and Infection Prevention and Control.    Able to provide functional direction to other team members.  Adheres to hospital and departmental policies and procedures. Provide for the effective use of information technology within the hospital. 

What is required:
Graduate of an Accredited School of Nursing
Three years nursing experience in a hospital setting

Current Georgia RN Licensure as required
Current BLS certification