The Program Manager, Private Payer Advocacy reports to the Senior Manager, Advocacy.
Bachelor’s degree or equivalent required, with an advanced degree preferred, along with 3+ years of work experience in a healthcare environment. Previous work experience with knowledge of health plan contracts, reimbursement policies, appeals processes, and coverage decisions required. Excellent written, oral presentation, and interpersonal skills are essential. Proficiency in word processing, spreadsheets, PowerPoint, and databases mandatory. Strong customer/member focus with building relationships, issue identification and resolution, problem-solving, and project management skills. Ability to operate independently and handle multiple projects with a high degree of initiative. Limited travel required.
- Maintain a high level of knowledge on private payer policies impacting physician members.
- Monitor and analyze private payer advocacy issues by reviewing monthly payer newsletters, announcements, and websites, and attending meetings, conferences, and other activities.
- Develop marketing materials, practice management resources, and grassroots messages to assist members in payer advocacy issues to optimize reimbursement for services.
- Correspond with Academy members, via both e-mail and phone, responding to payer policy and practice management requests.
- Track medical policy review requests from private payers, assist in drafting official comment letters in response, and help facilitate meetings/calls with leadership.
- Monitor member communications to identify private payer trends, draft category reports, and develop action plans to address national payer issues.
- Draft payer and reimbursement advocacy articles for AAO-HNS publications, including: the Bulletin, OTONews, and The ENT Advocate.
- Manage the update and review process for Position Statements, coordinating with appropriate AAO-HNS Board of Directors and its Committees.
- Develop new materials, resources, and tools to expand the knowledge base for members related to private payer and reimbursement issues.
- Represent the Academy at meetings, when requested, as part of the Advocacy team. Report back on key meeting agenda items pertinent to the AAO-HNS members.
- Participate in and provide summaries of Medicare’s Open Door Forum calls for Physicians and other pertinent conference calls from CMS, ONC, as needed.
- Serve as liaison or support other staff liaisons to assigned AAO-HNS Committees.
- Coordinate activities and projects with other Business Units, as applicable.
- Support mutually beneficial relationships with other medical societies, third party payers, and other professionals and organizations, as appropriate.
- Consistently demonstrate courteous, cooperative, and helpful behavior to all contacts, internal and external.
- Duties and responsibilities may be added, deleted, or changed at any time at the discretion of management, formally or informally, either orally or in writing.
Posted January 2018
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Mail: AAO-HNSF, 1650 Diagonal Road, VA 22314-2857 Attention: Human Resources