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Pps Credentialing Reviews Jobs (NOW HIRING)

... Review students' neuropsychological testing to ensure a holistic, supportive, and strength-based ... PPS (Pupil Personnel Services Credential in School Counseling or School Social Work), LCSW ...

REHAB REFERRAL COORDINATOR - REHAB

Wausau, WI · On-site

$19.25 - $25.25/hr

... who reviews patient referrals to the Rehab Unit, both in-house and from outside facilities ... FIM (Functional Improvement Measurement) credentialed. PPS certification desired. * Current ...

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Pps Credentialing Reviews information

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How much do pps credentialing reviews jobs pay per hour?

As of Jul 18, 2026, the average hourly pay for pps credentialing reviews in the United States is $24.36, according to ZipRecruiter salary data. Most workers in this role earn between $19.23 and $27.64 per hour, depending on experience, location, and employer.

What are the key skills and qualifications needed to thrive in PPS Credentialing Reviews, and why are they important?

To thrive in PPS Credentialing Reviews, you need a thorough understanding of healthcare regulations, credentialing standards, and provider enrollment processes, often supported by experience in healthcare administration or credentialing certification. Familiarity with credentialing software, such as CAQH or VerityStream, and knowledge of regulatory systems like NCQA or Joint Commission are typically required. Strong attention to detail, organizational skills, and effective communication are crucial soft skills for verifying credentials and liaising with providers. These competencies ensure compliance, minimize risk, and maintain the integrity and efficiency of healthcare provider networks.

What are some common challenges faced in a PPS Credentialing Reviews role and how can they be managed?

Professionals in PPS Credentialing Reviews often encounter challenges related to navigating complex regulatory requirements and ensuring timely processing of provider credentials. Attention to detail is critical, as errors or omissions can delay provider onboarding or impact compliance. Managing multiple credentialing cases simultaneously requires effective time management and clear communication with healthcare providers and internal teams. Proactively staying updated on changing regulations and maintaining organized documentation can help overcome these challenges and ensure a smooth credentialing process.

What are PPS Credentialing Reviews?

PPS Credentialing Reviews refer to the process by which healthcare providers are evaluated and verified to participate in the Medicare Prospective Payment System (PPS). This involves checking the provider’s qualifications, licensure, certifications, and compliance with regulatory standards to ensure they meet the requirements for reimbursement under PPS. The goal is to maintain high standards of care and prevent fraud, ensuring only eligible providers receive payment. These reviews are typically conducted by Medicare Administrative Contractors (MACs) or other credentialing bodies.

What is the difference between Pps Credentialing Reviews vs Medical Credentialing Specialists?

AspectPps Credentialing ReviewsMedical Credentialing Specialists
Primary FocusReviewing provider credentials for insurance networksManaging overall provider credentialing and enrollment
Work EnvironmentHealthcare organizations, insurance companiesHospitals, clinics, healthcare administration firms
Required CertificationsCredentialing review experience, knowledge of insurance policiesCredentialing certifications, healthcare administration background

While both roles involve credentialing processes, Pps Credentialing Reviews primarily focus on evaluating provider credentials for insurance purposes, whereas Medical Credentialing Specialists handle the broader credentialing and enrollment tasks within healthcare organizations. Understanding these differences helps employers and professionals target the right skills and responsibilities in the healthcare credentialing field.

More about Pps Credentialing Reviews jobs
What cities are hiring for Pps Credentialing Reviews jobs? Cities with the most Pps Credentialing Reviews job openings:
What states have the most Pps Credentialing Reviews jobs? States with the most job openings for Pps Credentialing Reviews jobs include:
Infographic showing various Pps Credentialing Reviews job openings in the United States as of July 2026, with employment types broken down into 9% Locum Tenens, 2% As Needed, 59% Full Time, 13% Part Time, and 17% Contract. Highlights an 94% Physical, 2% Hybrid, and 4% Remote job distribution, with an average salary of $50,665 per year, or $24.4 per hour.
PPS Coordinator (RN, PT, OT, or SLP)

PPS Coordinator (RN, PT, OT, or SLP)

Lifepoint Health

San Antonio, TX

Full-time

Posted 18 days ago


LifePoint Health rating

6.0

Company rating: 6.0 out of 10

Based on 265 frontline employees who took The Breakroom Quiz

746th of 886 rated healthcare providers


Job description

Title: PPS Coordinator (RN, PT, OT, or SLP)

Job Type: Full time

Your experience matters!

 

At Rehabilitation Institute of South San Antonio, we are driven by a profound commitment to prioritize your well-being so you can provide exceptional care to others. Here, you're not just valued as an employee, but as a person. 

The Rehabilitation Institute of South San Antonio is a 36-bed inpatient acute rehabilitation hospital located at 12011 SE Loop 410 Access Road in San Antonio, Texas. It's designed for individuals recovering from serious injuries or illnesses that have affected their ability to function independently.

This state-of-the-art facility provides intensive, patient-focused rehabilitation services, including physical, occupational, and speech therapy. It specializes in helping patients regain mobility, strength, and independence after events like strokes, traumatic injuries, or surgeries. 

As a PPS Coordinator joining our team, you're embracing a vital mission dedicated to making communities healthier. Join us on this meaningful journey where your skills, compassion, and dedication will make a remarkable difference in the lives of those we serve.

How you'll contribute 
The PPS Coordinator provides coordination of the timely and accurate data completion of the Inpatient Rehabilitation Facility-Patient Assessment Instrument (IRF-PAI) for each rehabilitation inpatient. This individual collects, reviews and monitors the information contained in the IRF-PAI, on each patient to ensure accuracy in the scoring of functional status and reflection status and reflection of the patient's care needs, as documented in the medical record and the UDS Pro-Doc system, in collaboration with the interdisciplinary team. This position will assist in the ongoing monitoring of identified outcome benchmarks for the inpatient population. The PPS Coordinator has access to confidential patient information and maintains all confidentiality of all information.
ESSENTIAL FUNCTIONS:
Job Specific:
Responsible for staff orientation and ongoing education to improve QI score accuracy at admission, throughout the stay and upon discharge. Serves as educator for Quality Indicators (QI) scoring according to Uniform Data System (UDS) training materials.
Serves as a resource to licensed clinicians and clinical staff regarding questions and interpretation of QI scoring guidelines, according to UDS training guidelines, in order to assure the accuracy of the QI scores.
Provides ongoing education to the staff of the hospital to assure accurate and timely completion of the IRF-PAI.
Responsible for staff orientation and ongoing education and facilitate biannual UDSMR staff credentialing for QI scoring.
Review medical record documentation using the medical record including UDS Pro-Doc system to support the accuracy and timeliness of the functional scores and comorbid conditions, according to CMS guidelines.
Ensures that the IRF-PAI is consistent with the medical record documentation and reflects the functional status and 24 hour care needs of the patient.
Collaborates with physicians and interdisciplinary team members to ensure the most accurate assessment of the needs and strengths of patients are captured in the UDS Pro-Doc system and in the medical record.
Review current facility clinical documentation in the medical record and UDS Pro-Doc and evaluate accuracy through the use of QI Manager.
Compares actual knowledge of the patient to care provided to the patient and the information contained on the IRF-PAI. Makes appropriate corrections to the IRF-PAI in collaboration with the interdisciplinary team in order to accurately reflect the burden of care upon admission, throughout the stay and upon discharge.
Investigates the Impairment Group Codes IGC and co-morbidities in collaborative manner with the physicians and coders that would allow for accurate coding of the patient's stay.
Oversees/completes and analyzes and QI data ensuring the accuracy and the completion of the Inpatient Rehabilitation Facility-Patient Assessment Instrument (IRF-PAI) according to CMS guidelines and prior to electronic transmission.
Reviews the medical record documentation to ensure accuracy and to support the correct Case Mix Group (CMG) assignments
Identifies target reference dates for the completion of the IRF-PAI for all patients.
Coordinates the completion of the admission assessment of the IRF-PAI by the fourth day of the patient's stay and the third day following discharge for each inpatient rehabilitation patient. May require discussions/interactions with various staff members concerning differences in reported and/or medical record documentation of functional status to complete the PAI. Uploads QI scores in UDS Pro-Doc necessary to complete the IRF -PAI.
Coordinates and collaborates with HIM department to ensure timely completion and transmittal of the IRF-PAI to CMS national database.
Maintains current knowledge of the UDS Pro-Doc system and CMS IRF-PAI software and provides expertise on the software within the inpatient rehab setting and contributes to facility process improvement plans.
Maintains updated and ongoing knowledge of the regulations concerning the IRF-PAI and its completion within the inpatient rehab setting.
Has working knowledge of capabilities of UDS Pro-Doc, including various reports and how to access and use.
Has working knowledge of UDS Pro-central, including various reports and how to access, interpret and use.
Serves as an information source and educator to IRF-PAI and UDS users.
Periodically performs medical record audits including audits of the IRF-PAI instrument, clinical documentation and billing information to ensure accuracy and consistency of documentation.
Demonstrates effective critical thinking skills
Other duties as assigned.

Qualifications and requirements:
Graduation from an accredited Bachelors of Science in Nursing, Associate Degree in Nursing or Nursing Diploma program or Licensed/Registered PT, OT, SLP
Current unrestricted state licensure as Registered Nurse (preferred) or PT, OT, SLP.
CRRN preferred
CPR/BCLS certification.
UDSMR PPS Certification within 3 years.
3+ years of experience in the care of patients in the acute hospital or rehabilitation setting preferred.
Excellent oral and written communication and interpersonal skills.

About us
Rehabilitation Institute of South San Antonio is located in San Antonio, TX, and is part of Lifepoint Health, a diversified healthcare delivery network committed to making communities healthier with acute care, rehabilitation, and behavioral health facilities from coast to coast. From your first day to your next career milestone-your experience matters.

EEOC Statement

"Rehabilitation Institute of South San Antonio is an Equal Opportunity Employer. Rehabilitation Institute of South San Antonio  is committed to Equal Employment Opportunity for all applicants and employees and complies with all applicable laws prohibiting discrimination and harassment in employment."

Lifepoint Health is a leader in community-based care and driven by a mission of Making Communities Healthier. Our diversified healthcare delivery network spans 29 states and includes 63 community hospital campuses, 32 rehabilitation and behavioral health hospitals, and more than 170 additional sites of care across the healthcare continuum, such as acute rehabilitation units, outpatient centers and post-acute care facilities. We believe that success is achieved through talented people. We want to create places where employees want to work, with opportunities to pursue meaningful and satisfying careers that truly make a difference in communities across the country.We employ and provide care to people from all walks of life. We are committed to promoting healing, providing hope, preserving dignity and producing value with an inclusive workforce in which diversity is leveraged, respected, and reflective of the patients, family members, customers and team members we serve.

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About LifePoint Health

Sourced by ZipRecruiter

Lifepoint Health serves patients, clinicians, communities and partners across the healthcare continuum. Our diversified healthcare delivery network extends from coast to coast, consisting of community hospitals, rehabilitation and behavioral health hospitals, and additional sites of care.

Industry

Health care and social assistance

Company size

10,000+ Employees

Headquarters location

Brentwood, TN, US

Year founded

1999

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