Prospective Payment System Coordinator ( PPS COORDINATOR )

Prospective Payment System Coordinator ( PPS

COORDINATOR

) Horizon Rehabilitation Hospital - 2.7 McKinney, TX Job Details Full-time 8 hours ago Qualifications Appeals Computer operation Document review (document control) Inpatient Medicare Computer literacy Basic math Insurance claim appeals processing Regulatory compliance in claims processing English Mid-level CMS regulatory compliance Analysis skills Bachelor's degree Task prioritization Decision making Centers for Medicare and Medicaid Services (CMS) Clinical documentation Medical insurance appeals management 1 year Regulatory audits Hospital regulatory compliance Technical Proficiency Hospital experience Full Job Description

JOIN US AND MAKE A DIFFERENCE!

Horizon Rehabilitation Hospital in McKinney is an innovative, state-of-the-art facility dedicated to providing exceptional, patient-centered healthcare services to our community. As a newly established 26-bed in-patient rehab hospital, we are committed to setting new standards in patient care and rehabilitation. We value compassion, excellence, and teamwork, and we are looking for an experienced, detail-oriented Full time PPS Coordinator to join our team. This a Monday-Friday 8am to 5pm position.

Job Responsibilities:

The PPS Coordinator is responsible for coordinating, monitoring, and ensuring compliance with Medicare Inpatient Rehabilitation Facility (IRF) regulatory requirements, including

IRF-PAI/PPS

reporting and the CMS IRF Review Choice Demonstration (RCD) program administered by Novitas. This role integrates clinical documentation review, regulatory compliance, data integrity, and medical review submission processes for Medicare Part

B IRF RCD

activities, including pre-claim review (PCR), post payment review, ADR management, appeals coordination, and audit readiness. The position serves as the primary operational liaison between the facility, Novitas, CMS, and internal clinical and billing teams. At Horizon Rehabilitation Hospital we are dedicated to creating a positive and supportive work environment where our employees can thrive while making a difference in the lives of our patients. Join us in shaping the future of healthcare and rehabilitation. We look forward to welcoming you to our team!

What we are looking for:

Bachelor's degree preferred. Minimum 1 year recent clinical experience in inpatient rehabilitation. Experience with medical review, audits, ADRs, or Medicare appeals strongly preferred. Knowledge of CMS IRF regulations, Medicare Part B billing, and Novitas processes preferred. Ability to project a professional image. Knowledge of regulatory standards and compliance requirements. Strong organizational, prioritizing and analytical skills. Ability to make independent decisions when circumstances warrant. Working knowledge of computer and software applications used in job functions. Freedom from illegal use of and effects of use of drugs and alcohol in the workplace.

Certificates, Licenses, Registrations:

A licensed or certified clinician who holds a current, valid, and active state license to practice as a healthcare professional. Attendance Regular and punctual attendance. Language Skills English is the primary language of the facility. Ability to read and write, communicate clearly with co- workers and customers and to respond to appropriate questions regarding work process or work product. Mathematical Skills Ability to add, subtract, multiply, and divide in all units of measure, using whole numbers, common fractions, and decimals. Ability to compute rate, ratio, and percent.

Reasoning Ability:

Ability to apply common sense understanding to carry out instruction furnished in written, oral and/or diagram form. Ability to define and solve problems and collect data.

Equal Opportunity Employer:

Horizon Rehabilitation Hospital is an equal opportunity employer and does not discriminate on the basis of race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, or veteran status.