IRF/PAI Coordinator

SUMMARY:

Using discretion and independent judgment, the IRF-PAI Coordinator, coordinates the process of providing accurate and timely data to the appropriate entities involved in the Prospective Payment System for Medicare patients.

The IRF-PAI Coordinator is a licensed clinician. In the IRF-PAI Coordinator role, this position coordinates with the Director of Quality / Risk to ensure IRF-PAI completion with the interdisciplinary team, gathering and input of data, transmission of data. The IRF-PAI Coordinator is responsible for coordinating the process of providing accurate and timely data to the appropriate entities involved in the Prospective Payment System for Medicare patients. The IRF-PAI Coordinator oversees all aspects of data collection on the IRF-PAI, ensures the presence of supporting documentation and provides staff education to ensure compliance with CMS guidelines.

This job directly affects all members of the clinical team through accuracy of data from medical chart to CMS transmission.

ESSENTIAL DUTIES AND RESPONSIBILITIES:

May include, but is not limited to the following:

To perform this job successfully, an individual must be able to perform each key function satisfactorily. Reasonable accommodations may be made to enable individuals with disabilities to perform the key functions.

OPERATIONS AND SUPPORT SERVICES:

• Demonstrates satisfactory level of interpersonal skills to interact with facility staff, Administration, patients, families, customers, vendors, and government agencies.
• Demonstrates and understands the importance of and respect for the rights, dignity, and individuality of each patient in all interactions.
• Demonstrates honesty and integrity at all times in the care and use of patient and hospital property.
• Knowledge of emergency and disaster procedures of the facility.
• Demonstrates respect for co-workers and responds to needs of patients by complying with hospital policies.
• Demonstrates ability to prioritize tasks/responsibilities and complete duties within allotted time.
• Appropriately accesses the resources of the companys resources for consultation and program development support. Seeks out external resources through conferences, workshops, etc. as necessary.
• Routinely shares professional knowledge with staff, managers and hospital personnel.
• Ability to carry out the essential functions of this job (with or without reasonable accommodation).
• Assure participation in relevant in-service training sessions.
• Attend and participate in facility meetings as required.
• Access continuing education opportunities appropriate to responsibilities.
• Participate in hospital wide patient safety program identifying risks to patient safety and reducing healthcare errors.
• Perform other duties as assigned.

SPECIFIC SKILLS:

• (1) Year of hospital-based case management and IRF-PAI Coordinator experience including utilization review and discharge planning
• Strong leadership skills
• Strong negotiation skills
• Skills in administrative functions of accountably, time management, and decision making
• Must be flexible to provide hands on case management as needed
• Must have great people skills, and have an ability to de-escalate problems with patients or families
• Review documentation of communication with patients, families, and physicians.
• Must be able to articulate effectively to family and patients and team members

Job Function

Approximate % of Time

Assess, plan, develop, implement and evaluate all performance improvement activities within department. Provide ongoing education to staff on performance standards. Develop culture of 100% compliance 100% of time. Collect and analyze outcomes and submit reports to regulatory agencies, administration, UR and MEC Committees.

45%

Retain current with literature related to department and maintain an updated methodology, tools, manuals and criteria as necessary and appropriate. Attends all required hospital meetings.

10%

Responsible for monitoring patient charts for correct coding, electronically transmitting data in a timely manner and communicating with a multidisciplinary team to create and carry out patient treatment plants. Monitor program compliance with charging for Medicare Services. (CMS)

45%

QUALIFICATIONS:

Education:

Graduate from a school of nursing. Bachelors Degree preferred.

License/Certification:

Current active license in degreed healthcare related field for the state of practice. Current Basic Life Support (BLS) CPR certification through the American Heart Association. Must maintain license and certification throughout employment.

Experience:

(1) One year experience an IRF-PAI Coordinator and (2) Two years experience in an acute hospital setting preferred. Ability to project a Professional Image. Knowledge of regulatory standards, compliance requirements and hospital policies and procedures. Working knowledge and ability to apply professional standards of practice in job situations.

Strong organizational and analytical skills. Working knowledge of computer and software applications used in job functions (Order entry, data entry). Knowledge of Acute Rehab.

SUPERVISORY RESPONSIBILITIES:

N/A

OTHER REQUIREMENTS:

Participates in or conducts company-wide sponsored training to safeguard against improper use and disclosure of patients protected health information. Monitors and ensures compliance with company policies, procedures, state and federal regulations and Accreditation Standards.

Company Specific

• Adheres to dress code, appearance is neat and clean and wears appropriate identification while on duty.
• Adheres to all smoking or tobacco regulations established by corporate building owners, state, or federal laws.
• Completes annual health, safety, and education requirements. Maintains professional growth and development.
• Maintains confidentiality of all patient and/or employee information to assure patient and/or employee rights are protected.
• Demonstrates knowledge of the principles of growth and development and the skills necessary to provide age appropriate care to the patient population served.
• Reports to work on time as scheduled; adheres to policies regarding notification of absence.
• Attends all mandatory in-services and staff meetings.
• Represents the organization in a positive and professional manner.
• Complies with all organizational policies regarding ethical business practices.
• Communicates the mission, ethics, and goals of the hospital, as well as the focus statement of the department.
• Maintains current licensure/certification for position, if applicable.
• Consistently demonstrates superior customer service skills to patients, physicians, visitors, employees, and any other individuals with whom they may come in contact.

• Consistently follows departmental and hospital Health, Safety, Security, Hazardous Materials policies and procedures.
• HIPAA: Conduct job responsibilities in accordance with HIPAA privacy laws, follow hospital policy in provision of patient confidentiality. Able to identify patient confidentiality issues and reports to proper hospital personnel immediately.

• Compliance: Conducts job responsibilities in accordance with standards set forth in Code of Conduct, policy and procedures, applicable federal and state laws, and applicable standards.

Professionalism To always maintain the highest standard and regard for others. Keep skills, competencies and required licensures/certifications current; displays mastery over attitude and behavior and pride in appearance. Consistently performs duties to the best of abilities.

Exceptional CareGo above and beyond expectations by providing exceptional care to WOW our customerspatients, family, physicians, and each other.

Respect Treating others as they would like to be treated; valuing others. Acknowledges the worth of others through professional greetings, proper telephone etiquette, patience, and common courtesy.

Fun - Having fun and celebrating small successes in our journey to achieve big. Always demonstrates a positive attitude toward work and devotion to our passion and task at hand.

Teamwork To function as a unit, with common goals, recognizing we can achieve far more as a team than as individuals. Cooperates with co-workers while performing duties leading to everyone being able to achieve success and giving recognition where it is due.

Integrity To always be honest and trustworthy in all our relationships. Demonstrates adherence to a strict moral or ethical code in performance of duties by always seeking to do the right thing.

Accountability -- Responsibility of our actions that influence the lives of our customers and fellow workers. Takes ownership of all aspects of duties shown through reliable, timely performance and responsibility.

Responsibility Maintains accountability by doing what is expected or beyond; assuring the appropriate tasks and project items are completed. Takes ownership of all aspects of duties shown through reliable, timely performance and accountability.

• Ability to function independently in all aspects, including project identification, evaluation, contract negotiations, and coordination with management and internal departments.
• Ability to represent the company in a confident, persuasive and positive manner.
• Good interpersonal, verbal and written communication skills.
• Ability to work under stress and respond quickly in emergency situations.

DESCRIPTION OF PHYSICAL DEMANDS AND WORK ENVIRONMENT

Show the amount of time spent on-the-job in the following physical activities by checking the appropriate boxes below.

Amount of Time

None

Occasionally
up to 1/3

Frequently
1/3 to 2/3

Constantly
2/3 or more

Stand:

X

Walk:

X

Sit:

X

Talk or hear:

X

Finger, handle or feel:

X

Push/Pull:

X

Stoop, kneel, crouch or crawl:

X

Reach with hands and arms:

X

Taste or smell:

X

This job requires that force be exerted by weight being lifted, carried, pushed, or pulled. Show how much and how often by checking the appropriate boxes below.

Amount of Time

None

Occasionally
up to 1/3

Frequently
1/3 to 2/3

Constantly
2/3 or more

Up to 10 pounds:

X

Up to 20 pounds:

X

Up to 50 pounds:

X

Up to 100 pounds:

X

> 100 pounds:

X

This job has special vision requirements.

Check all that apply.

[X] Close Vision (clear vision at 20 inches or less)

[X] Distance Vision (clear vision at 20 feet or more)

[X] Color Vision (ability to identify and distinguish colors)

[X] Peripheral Vision (ability to observe an area that can be seen up and down or to the left and right while eyes are fixed on a given point)

[X] Depth Perception (three-dimensional vision; ability to judge distances and spatial relationships)

[X] Ability to Adjust Focus (ability to adjust eye to bring an object into sharp focus)

[ ] No Special Vision Requirements

1. This job has special hearing requirements.

Check all that apply.

[X] Ability to hear alarms on equipment

[X] Ability to hear client call

[X] Ability to hear instructions from physician/department staff

Specific demands not listed: