The purpose of this statement of work is to obtain technical expertise of a senior health care policy analyst to assist the client in the development and the implementation of the Shared Savings Program and other value-based purchasing (VBP) initiatives such as the value-based payment modifier and Hospital VBP relative to Medicare & Medicaid services.
- Works directly with Medicare as a Technical Advisor directing Medicare fee for services operations, policy planning and analysis.
- Experience should include in depth knowledge of the requirements to implement ACA health care reform initiatives
- Knowledge must span Medicare fee-for-services payment policies, the Shared Savings Program, Physician Value Modifier, and other value based purchasing programs.
- Extensive experience in establishing, developing, planning and implementing pay for reporting, pay for performance, and value-based purchasing strategies within Medicare fee-for-service payment systems.
- Ability to develop, evaluate and interpret legislation, existing regulations and manuals
- Knowledge and understanding of Title XVIII of the Social Security Act;
- Knowledge and understanding of the Medicare Improvement for Patients and Providers Act (MIPPA), Patient Protection and Affordable Care Act (PPACA) and legislation pertinent to CMS' value-based purchasing and quality care initiatives;
- Extensive experience planning, developing and implementing Medicare Shared Savings Program and Physician Value Modifier regulations.
- Bachelor's Degree required in Business or Health Care related field with coursework in math, statistics, process improvement or project management preferred. Master's Degree in related field preferred.
- Thorough and functional understanding of the Medicare program and payment policy areas, provider structures, and beneficiary populations.
- Experience navigating, Department of Health & Human Services, Office of Legislation and Office of Management and Budget clearance processes.
- Knowledge of the operations and management of Medicare fee- for-service payment systems.
- Experience communicating with organizations internal and external to Medicare about Medicare related policies.
- Thorough and functional knowledge of risk adjustment and payment standardization methodologies, including the specific methodologies used by Health and Human Services.