The Manager, Reimbursement and Practice Policy manages Society activities related to practice, with a particular focus on Medicare physician coverage and reimbursement issues, Medicaid policy, as well as the impact of evolving health care systems on hematologists. In addition, the Manager will focus on practice policy issues including quality measure reporting, drug cost, health care access, and laboratory testing/hematopathology issues. The Manager works with the ASH Committee on Practice and its Subcommittee on Reimbursement, the Committee on Government Affairs, the ASH Practice Partnership, and ASH’s scientific committees to formulate suggested policy for the Society.
ESSENTIAL DUTIES AND RESPONSIBILITIES (Duties that occupy a major portion of time and importance in the job)
Works with physician volunteers and consultants to coordinate policy and advocacy activities concerning practice related issues of importance to hematologists, including Medicare physician reimbursement, Medicaid policy, quality reporting issues, and health system and health insurance reform.
Assists in directing the activities of the Government Relations and Practice Department, including:
Working with the Chief Policy Officer on policy strategy and programmatic activities related to the practice of hematology.
Recommending annual advocacy agenda and formulating suggested policy for the Society related to physician reimbursement issues (Medicare and Medicaid policy, and private insurance issues), sickle cell disease, quality reporting and pay for performance measures; drug access and cost; health care access; palliative care; and lab/genetic testing/hematopathology issues, consistent with Society policy and political opportunity.
Assisting in the preparation of the annual departmental budget concerning activities of the Committee on Practice and its Subcommittee on Reimbursement.
Managing the Subcommittee on Reimbursement (of the Committee on Practice) on coverage and reimbursement policy and working collaboratively with the Policy & Practice Manager on identifying resources and tools for the Committee on Practice.
Manages practice related policy and activities, including:
Monitoring, analyzing, and preparing comment letters in response to legislation, regulations, and public policy issues.
Preparing ASH Policy Statements that impact the practice of hematology and periodically reviewing them to ensure accuracy and relevance to current events.
Preparing written correspondence and reports and oral presentations for Society committees, the membership at large, and external meetings (e.g., CMS, AMA specialty society meetings, reimbursement/coverage related meetings, state society calls).
Reviewing practice related policy summaries as prepared by ASH policy consultants.
Managing work with AMA House of Delegates and AMA CPT/RUC alongside consultants including participation in relevant calls and meetings.
Working closely with Communications Department in the development of ASH press statements and ASH Clinical News articles related to practice related policy.
Identifying opportunities and assisting ASH practice members with compliance to MACRA rules, i.e., alternative payment models and MIPS program.
Responding to questions from members on practice, coverage and reimbursement issues.
Identifying and implementing Grassroots Network advocacy opportunities in coordination with the Senior Manager, Legislative Advocacy.
Coordinating with the Quality Department regarding policy related quality initiatives (i.e. MACRA implementation i.e., quality measures, guidelines, clinical practice improvement activities, apps and other practice resource tools).
Coordinating with the scientific committees on issues and policy related to practice, quality of care, reimbursement and coverage, as appropriate.
Co-lead development of the Medicare Carrier Advisory Committee (CAC) meeting by identifying reimbursement, coverage and health care access policy content and follow up on CAC issues in coordination with the Policy & Practice Manger.
Attends external meetings and briefings related to practice issues (i.e., AMA Specialty Society meetings, SAGSA, Cognitive Care Alliance, ACP Council of Medical Specialty Societies, other coalition meetings).
Coordinates with related public, patient, and professional organizations and coalitions.
Occasional attendance at and/or support of ASH-sponsored meetings and events outside of normal working hours (evenings and/or weekends).
QUALIFICATIONS, KNOWLEDGE SKILL REQUIRED (Minimum education and experience needed to perform the job adequately)
Minimum of five years professional work experience working on Medicare, Medicaid, private health insurance, quality of care, delivery system reform, health care access and physician coverage and reimbursement issues within a health-related organization, medical society, Capitol Hill, or Administration.
Working knowledge of Medicare/Medicaid, alternative payment models, and health care delivery systems and practice settings preferred.
Strong analytical and excellent oral and written communication skills, and project management skills required.
Detail-oriented, with excellent organizational and follow-through skills.
Experience working with Congress and federal agencies (CMS/CMMI) preferred.
Prior supervisory experience preferred.
Basic computer word processing skills, including MS Office and Internet navigation required.