ZipRecruiter

Log In

1

Pps Credentialing Reviews Jobs (NOW HIRING)

Care One at Weymouth

RN MDS Coordinator

East Weymouth, MA · On-site

$93K - $99K/yr

... qualifications, credentials and any other relevant information The Clinical Reimbursement ... By conducting concurrent MDS reviews, he/she assures the achievement of maximum allowable RUG ...

Care One at Weymouth

RN MDS Coordinator

Weymouth, MA

$93K - $99K/yr

... qualifications, credentials and any other relevant information The Clinical Reimbursement ... By conducting concurrent MDS reviews, he/she assures the achievement of maximum allowable RUG ...

Cascades Healthcare

Regional MDS Coordinator

Provo, UT · On-site

$32.50 - $41.50/hr

RAC-CT credential strongly preferred. * Experience: Minimum of three years experience in a ... Strong audit, compliance review, and reimbursement analysis skills. * Ability to manage multiple ...

Cascades Healthcare

Regional MDS Coordinator

Provo, UT · On-site

$32.50 - $41.50/hr

RAC-CT credential strongly preferred. * Experience: Minimum of three years experience in a ... Strong audit, compliance review, and reimbursement analysis skills. * Ability to manage multiple ...

Cascades Healthcare

Regional MDS Coordinator

Provo, UT

$32.50 - $41.50/hr

RAC-CT credential strongly preferred. * Experience: Minimum of three years experience in a ... Strong audit, compliance review, and reimbursement analysis skills. * Ability to manage multiple ...

next page

Showing results 1-20

All JobsPps Credentialing Reviews Jobs

Pps Credentialing Reviews information

See salary details

$13

$24

$38

How much do pps credentialing reviews jobs pay per hour?

As of Jul 19, 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:
What job categories do people searching Pps Credentialing Reviews jobs look for? The top searched job categories for Pps Credentialing Reviews jobs are:
Pps Credentialing Reviews jobs near you
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.
Director of Patient Outcomes

Director of Patient Outcomes

ClearSky Health

Eau Claire, WI

Full-time

Medical, Dental, Vision, Retirement

Posted 18 days ago

Job description

Our hospital provides high-quality care that transforms the lives of those living with disabling injuries and illnesses. We distinguish ourselves through our commitment to excellence, to our patients, to our employees, and to the communities we serve.

We're proud to announce the Winter 2026 grand opening of ClearSky Rehabilitation Hospital of Eau Claire, WI!

As we prepare to open our doors, we're seeking a passionate and experienced Director of Patient Outcomes to join our founding leadership team. This is a unique opportunity to help shape clinical quality, performance improvement, and patient safety at a brandnew, stateoftheart rehabilitation hospital.

If you're a dedicated clinician driven to improve patient outcomes and make a meaningful impact, you'll find a rewarding career with a growing healthcare organization committed to excellence in patientcentered care. We invite you to be a vital part of our journey from the very beginning.

Click here to watch a video and learn more about what it is to be a part of the ClearSky Rehabilitation team.

🌟 What We Offer: Your Path to a Rewarding Career Starts Here! 🌟

  • Competitive Compensation
  • Comprehensive Benefits Package including Medical, Dental, Vision
  • 401k Matching
  • Student Loan Repayment and Tuition reimbursement
  • Professional Development Opportunities to include CEU Opportunities
  • Health and Wellness Programs
  • Career Advancement
  • Inclusive and Supportive Culture
  • Work Life Balance
  • Employee Recognition Program

Our Director of Patient Outcomes is responsible for directing the completion of the Inpatient Rehabilitation Facility Prospective Payment System (IRF PPS). Provides clinical support in completion of data contained in prospective payment system (PPS) and functional outcome measure (FOM) instruments for each patient to ensure accuracy in the scoring of functional status and reflection of the patient's care needs.

Job Duties include, but are not limited to:

  • Lead and direct the case management department as assigned, to include: management of staffing needs, and caseloads; education, direction, and mentorship of the Case Management Team, and reporting and assistance in the management of patient outcomes.
  • Reports and assists in management of patient outcomes. To include; attending Utilization Reviews and reports as necessary (including managing medical necessity denials), collecting data and monitors Quality Indicators and the Care Tools, maintains FOM credentialing and staff education as well as FOM functions, ensuring accuracy (rounds, education, certification, etc.), reviewing physician documentation for medical necessity and function changes and tracks Compliancy (CMS13) and assists in attainment of required documentation from clinical liaison's and physicians to support.
  • Attends Operations/Admissions meetings and reviews patients for tiers and compliance. As well as attending team conferences and assisting Health Information Management (HIM) with accuracy of coded tiers with queries.

Requirements for consideration:

  • Clinical licensure required (PT, OT, SLP or RN preferred). Other licensure/certification to be considered based on appropriate qualifications.
  • Two years of recent experience in acute care setting preferred
  • Must maintain acceptable driving record, current driver's license and insurability

We value our employee's skills, talents and input. We believe in maintaining hospital environments where employees are valued, treated with dignity, respected, provided educational and training opportunities recognized and rewarded. These values are included in our competitive and comprehensive compensation and benefits.

Apply