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Reimbursement Policy Manager

DEPARTMENT

Practice Affairs
BASIC FUNCTION

Advance the activities of ACEP’s Reimbursement Department to promote fair payment for emergency physicians through: advocacy related to state legislation/regulation, its impact on policy for Medicaid payment and private insurer payment practices; advocacy for the interests of emergency medicine in the development and valuation of medical practice and procedure codes through the AMA’s RUC and CPT processes; and serving as a content expert in assisting members, state chapters and external organizations to obtain and provide expertise on key public policy issues impacting physician reimbursement.

Characteristic Duties and Responsibilities

  1. Identify and develop advocacy resources, strategies, and tactics to meaningfully assist ACEP’s state chapters engaged in state legislative and regulatory efforts related to private insurer and Medicaid payment issues.

  2. Coordinate with the Director of Chapter and State Relations to implement a strategy to ensure reimbursement-related legislation at the state level is identified and tracked and that chapters are fully engaged, educated, equipped and supported to effectively advocate on those issues.

  3. Serve as a trusted subject-matter expert to college leaders, staff, chapters, members, and external organizations on state Medicaid payment policies and private insurer payment practices that have a direct and meaningful impact on emergency physicians.

  4. Research issues and impacts of pertinent payment Medicaid and private insurer policies and practices in order to identify and cultivate potential data sources.

  5. Work with external organizations including other emergency medicine organizations, national medical specialties, and state medical societies to help maintain open communications and effective coordination of joint activity related to reimbursement issues of joint interest.

  6. Support the Reimbursement Director in effectively advocating for emergency physicians’ interests within the AMA’s RUC and CPT code development and valuation processes in order to become familiar with application, influential participants and political considerations that support the development of resources and strategies. 

  7. Assist in researching issues, including surveying member physicians on emergency practice experience as needed to support advocacy efforts before the RUC.

  8. Assist the Reimbursement Committee, the Coding and Nomenclature Committee and the State Legislative/Regulatory Committee as needed, for reimbursement-related objectives.

  9. Become and serve as a trusted content expert on coding and billing policy and issues in order to help physician members address relevant questions and concerns.

  10. Monitor and assist the Reimbursement Director and College leaders to devise and implement strategies to address overarching issues related to payment policy. (i.e. Alternative Payment Models and Accountable Care Organizations).

  11. Attend educational and business meetings as necessary.

  12. Utilize excellent diplomacy, oral and written communication skills, and be able to appropriately safeguard confidential information.

  13. Perform other duties as assigned by supervisor.

  14. Some travel will be required.

Relationships and Contacts

Reports to:

Director of Reimbursement

Internal Contacts:

Staff in all departments, significant interaction with the Director of Chapter and State Relations

External Contacts:

ACEP leaders, chapters, and members; state agency officials and staff; consultants; attorneys; researchers; staff of other medical societies; and representatives of other professional organizations and business

Required Education and Experience

  1. Bachelor's degree required (preferably in, political science, public administration, business administration or the medical field).

  2. Minimum of five years’ experience in public policy/advocacy work, preferably at the state level and ideally in the health care and/or reimbursement arena.

  3. Computer skills in word processing, Excel, and database management.

  4. Demonstrated success in implementing program(s) and strategic priorities, as well as exceptional organizational and planning skills.

  5. Ability to represent ACEP effectively to external and internal stakeholders.

  6. Exceptional writing and analytical skills, with the ability to conceptualize and synthesize issues creatively and develop comprehensive and insightful reports and recommendations.

  7. Excellent decision-making and problem-solving skills.

  8. Must possess the ability to multitask in a deadline driven environment. 

  9. Candidate must be organized, innovative, flexible, member focused, and a team player.

  10. Must be able to work independently within the framework of established parameters and timelines.

Other Desired Qualifications

  1. Experience with advocating on issues related to physician reimbursement policy.

  2. Familiarity with RUC processes as well as CPT and ICD-10 Coding.

  3. Master’s degree in relevant field desirable.

  4. Membership association experience.

  5. Experience in developing, implementing, and coordinating strategies with external entities such as CMS, AMA, RUC, and CPT Editorial Panel.

We are an equal opportunity and E-Verify employer who offers a competitive salary, an excellent benefits package, a retirement plan and more.

If you have questions regarding this position or would like to submit your resume, please contact us.

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