Payment Policy and Reimbursement Associate     

Location

Rosemont, Ill.

Status

Exempt

Reports To

Health Policy, Quality, and Reimbursement Director

Overview

The Payment Policy and Reimbursement Associate is responsible for monitoring, analyzing, and summarizing federal and state regulations—such as the No Surprises Act and State balance billing laws—that affect physician reimbursement. Additionally, this Associate will track Medicare, Medicaid, and commercial payer policies that impact the coverage of oral and maxillofacial surgery procedures, as well as directives from HHS, CMS, and other regulatory bodies that impact physician reimbursement. This role involves conducting extensive research and interpretation of such policies to support the Association, Director, and/or Committee in determining when necessary to advocate for members or when its necessary to educate the membership about relevant governmental and payer policies affecting their coding and reimbursement. This Associate will also prepare written drafts of comment letters to CMS in response to proposed rules when necessary. The Payment Policy and Reimbursement Associate will also actively participate in the AMA Relative Value Scale Update Committee (RUC) process and collaborate with the ADA Advisors sitting on the RUC Advisory Committee with coordinating submissions of recommendations for physician work values and practice expense inputs when necessary.

Salary Range $68,000-$73,000 per year

Benefits:

• Medical insurance with prescription drug coverage
• Dental Insurance
• Short-term and long-term disability
• Life insurance
• 401K plan with matching
• Paid time off (PTO)
• Flexible schedule
• Hybrid work schedule
• Employee assistance program
• Flexible spending account

Qualifications

• Bachelor’s degree in public health, health policy, political science, or equivalent experience
• Understanding of U.S. health system and current health policy issues
• Experience with health policy research, writing and analysis, and physician practice management.
• Excellent verbal and written communication skills
• Strong analytical skills
• Ability to work independently and collaboratively.
• Excellent organizational, time and project management skills
• Must be able to lift up to 50 lbs.
• Ability to travel, up to 10%.
   

Preferred Qualifications

• Knowledge of Medicare, Medicaid, and commercial insurance policies
• Experience in an oral and maxillofacial surgery practice and/or previous association work
• General knowledge of OMS; medical or dental clinical practice; and/or familiarity with surgical specialty
• Experience with Current Procedural Terminology (CPT), Current Dental Terminology (CDT), and Internal Classification of Diseases (ICD-10-CM)
• Knowledge of medical and dental terminology and physiology
• Ability to assist with coding and billing issues.
• Understanding of basic marketing skills
   

Key Accountabilities

The Payment Policy and Reimbursement Associate plays a key role in developing and maintaining the association’s coding and billing resources and courses. This Associate also provides support to members on dental and medical billing and as well as to the AAOMS Committee overseeing these initiatives.

To fulfill these responsibilities, the Payment Policy and Reimbursement Associate must stay informed about medical and dental coding changes as well as with current Medicare and/or third-party payer coverage and claim filing policies. This Associate must be comfortable with research; familiar with the insurance and reimbursement system; proficient in payment policy analysis; and possess excellent written skills. A solid understanding of healthcare policy and its impact on physician reimbursement is essential. Prior experience with ICD-10-CM, CPT, and CDT coding is preferred.

Monitoring, Analyzing, Interpreting Regulations and Payer Policies:
The Payment Policy and Reimbursement Associate will monitor Federal and commercial payer policies to stay abreast of coding and/or reimbursement policy changes impacting oral and maxillofacial surgeons. The Payment Policy and Reimbursement Associate will also prepare written summaries of such policies or rules. When needed, this role will draft written responses to assist the Director and Committee in advocating on behalf of the membership. This Associate will also attend RUC Committee meetings and collaborate with the AAOMS/ADA Advisors in responding to RUC initiatives when relating to OMS procedures.

Contribution and Maintenance of Coding & Billing Resources and Courses:
The Payment Policy and Reimbursement Associate will write and maintain reimbursement and payment policy content for AAOMS publications, newsletters, and website. This position will also contribute to the development, planning, and marketing of the AAOMS coding and billing courses. This Associate will also assist with on-site staff support by attending each in-person workshop.

Member & Committee Assistance:
The Payment Policy and Reimbursement Associate also provides year-round staff support to the Committee on Health Care Policy, Coding, and Reimbursement and assists members with selecting appropriate codes and/or troubleshooting claim denials. The Payment Policy and Reimbursement Associate also assists with preparing meeting agendas and meeting minutes; coordinating committee projects; and committee meeting logistics.