Senior Healthcare Policy Analyst
FM Talent Source - Baltimore, MD

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Position Overview:

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.