Staff Associate, Health Policy and Quality Improvement
REPORTS TO: Reimbursement Manager
The Health Policy and Quality Improvement Staff Associate, reports to the Reimbursement Manager and works with the Coding and Reimbursement Senior Staff Associate in providing staff support to the Committee on Healthcare Policy, Coding and Reimbursement (CHPCR). Responsibilities include coordinating the CHPCR’s projects, planning of the committee’s annual meeting and occasional conference call and development of meeting minutes and recommendations. The Health Policy and Quality Improvement Staff Associate also assists with responding to membership inquiries related to CPT, CDT and ICD-10-CM coding systems as well as to various reimbursement, billing and related health policy issues.
The Health Policy and Quality Improvement Staff Associate monitors trends associated with the electronic health record as it relates to coding and reimbursement. Responsibilities also include monitoring the National Uniform Claim Committee (NUCC), Workgroup for Electronic Data Interchange (WEDI), and American Dental Association (ADA) for updates to the medical and dental claim forms. The Health Policy and Quality Improvement Staff Associate is also responsible for monitoring changes made to the HIPAA Electronic Transactions and Code Sets Standards and its effect on claim filing and reimbursement. This position also monitors and reports on updates to coding and claim edits stemming from the Correct Coding Initiative and Medicare’s Medically Unlikely Edits.
The Health Policy and Quality Improvement Staff Associate also monitors new physician quality improvement measures and activities, as well as new healthcare reform initiatives such as the accountable care organizations, medical home model, alternative payment models, and other new clinical quality improvement and health policy regulations. The Health Policy and Quality Improvement Staff Associate assists in the development and implementation of quality improvement activities and resources for the specialty. This position is to monitor CMS initiatives and attend the AMA Physician Consortium for Performance Improvement (PCPI) meetings and other related meetings. The Health Policy and Quality Improvement Staff Associate is responsible for developing content for the Health Policy Perspectives column within the AAOMS Today as well as policy related submissions to the AAOMS website, Advocacy E-Newsletter and OMS Communiqué.
The Health Policy and Quality Improvement Staff Associate is responsible for tracking Medicare and private payer policies as well as state and federal insurance codes of interest to OMS to better identify areas of concern as well as to provide to members in response to general inquiries. This includes monitoring each state’s insurance code, the AAOMS Government Affairs Legislative Update, the Federal Register, CMS website and other readings or website research.
The Health Policy and Quality Improvement Senior Associate assists with the coordination of the in-person and online Coding and Billing courses, providing on-site staff support at the three in-person workshops per year. In addition, the Health Policy and Quality Improvement Staff Associate serves as the staff liaison to the AMA CPT Editorial Panel and assists the Reimbursement Manager with the CPT and ICD-10-CM coding proposal processes (additions/deletions/revisions) to ensure that these coding systems keep up with current practice. This is achieved via liaison with the American Medical Association and the National Committee on Vital Health Statistics. The Health Policy and Quality Improvement Staff Associate will also shadow the Reimbursement Manager on activities related to the AMA’s Relative Value Update Committee (RUC). The Health Policy and Quality Improvement Staff Associate attends these various meetings as necessary.
Provide technical and staff support to the Committee on Healthcare Policy, Coding and Reimbursement
Monitor trends and regulations concerning electronic health record documentation, physician quality assessment, performance measures, and healthcare reform initiatives.
Monitor the NUCC and WEDI websites for changes made to the medical claim form
Assist with the maintenance and marketing of online and in-person coding and billing courses, webinars, and resources
Prepare and coordinate new/revised code proposals
Maintain tracking system on coding and reimbursement trends as well as state and federal insurance codes, policies and regulations
Develop resources and/or publications to assist the membership with coding, reimbursement, health policy and quality improvement measures
Serve as an advisor in responding to member inquiries on issues related to coding and reimbursement
Monitor CPT and RUC activities, including meeting participation
Provide back-up support for the Reimbursement Manager
Provide heavy phone coverage (up to 20+ calls per day)
Monitor and refresh regulatory compliance page of AAOMS website
Strong verbal and written communication skills
Ability to work independently but collaboratively
Time and Project management skills
Knowledge of Current Procedural Terminology (CPT) and Current Dental Terminology (CDT) coding systems, and Internal Classification of Diseases (ICD) coding system
Knowledge of medical and dental terminology and physiology
General knowledge of OMS, medical or dental clinical practice, specific familiarity with frequently utilized procedures
Knowledge of government and private payor policies
Excellent organizational skills
Understanding of basic marketing skills
Must be able to lift 50 lbs.
Additional Salary Information: Salary Commensurate with experiecne
Established in 1918, the American Association of Oral and Maxillofacial Surgeons (AAOMS), the professional organization representing more than 9,000 oral and maxillofacial surgeons in the United States, supports its members' ability to practice their specialty through education, research, and advocacy. AAOMS members comply with rigorous continuing education requirements and submit to periodic offi...ce examinations, ensuring the public that all office procedures and personnel meet stringent national standards.