POSITION SUMMARY
Serve as a lead point of contact for members in resolving problems with Medicare & work collaboratively with the Assoc Director Payer Relations on payment and coverage issues with other third-party payers. Provide coverage for practice management helpline.
DUTIES & RESPONSIBILITIES
- Serve as liaison to the AMA CPT and RUC
- Activities include document review, meeting preparation (including drafting of coding proposals, RUC survey process), meeting attendance, and research as necessary.
- Develop and maintain communication channels with CMS, other federal and state agencies, and other relevant organizations (e.g., MedPAC, GAO) to help APA provide feedback on activities that relate to coding and payment.
- Attend and represent APA at coalition meetings
- Analyze impact of federal regulatory and legislative proposals on coding and payment policy for psychiatry and develop APA policy positions, and assist with related issues, as needed.
- Maintain knowledge of Medicare and Medicaid policies relating to all aspects of psychiatric care.
- Serve as a lead point of contact for members in resolving problems with Medicare & other third-party payers in the areas of payment & coverage. Provide coverage for helpline.
- Develop educational materials (i.e., FAQs, Webinars) for APA members on CPT coding and documentation, and major coverage policies.
- Staff liaison for Committee on RBRVS, Codes and Reimbursement and Committee on Reimbursement for Psychiatric Care
COMPETENCIES
The Senior Manager, Reimbursement Policy’s performance on these duties and responsibilities will be measured using the following competencies:
SCOPE & IMPACT
- Performs tasks that significantly impact Department of Reimbursement Policy and require the ability to gather, organize, verify, compose, and/or analyze established concepts, policies, and procedures to complete several multistep functions (i.e., RUC survey process, CPT CCP submission and review process)
- Responsible for specific daily activities related to CPT coding and documentation, and reimbursement and coverage policies.
- Demonstrates proficiency in the use of specialized skills and techniques
- Success is frequently measured by completing a complex set of tasks and demonstrating complex and nuanced individual and group work environment behaviors
COMPLEXITY, PROBLEM SOLVING & DECISION-MAKING
- Exercises judgment to choose a work method/procedure and to schedule tasks appropriately to meet guidelines
- Must demonstrate sound decision-making in a range of situations
- Has authority to make decisions relevant to day-to-day operations
- Identifies complex problems and issues. Designs and implements solutions with management approval
- Recognizes out-of-scope problems and escalates them to the appropriate level
RELATIONSHIP MANAGEMENT & AUTHORITY
- Relationships span levels internally and externally and center on collaborative work efforts
- Has regular contact with outside partners and organizations (i.e., AMA, AACAP, Psychology, Social Work)
- Has extensive contact with management, staff, and colleagues across departments to identify, learn, explain, and report on key issues, trends, and challenges
- Uses diplomatic skills to obtain trust, cooperation, and understanding in order to resolve more complex problems
- May represent the organization as a liaison to APA governance and other external coalitions and audiences with guidance from supervisor (i.e, Committees on RBRVS and Reimbursement)
ORGANIZATIONAL KNOWLEDGE
- Demonstrates a full understanding of the work or project team's relationships and responsibilities within the department
- Demonstrates a thorough working knowledge of policies, procedures, and terminology of the related department/field
SUPERVISION
- Coaches and mentors junior level staff
