Sr Health Policy Analyst

TITLE:

Senior Health Policy Analyst

REPORTING RELATIONSHIP:

Senior Director, Child Health Financing Strategy

BASIC FUNCTIONS:

Manage the Committee on Child Health Financing (COCHF) and its subcommittee, the Payer Advocacy Advisory Committee (PAAC), and the Pediatric Council. Work with COCHF in identifying, developing and revising new policy statements related to both public and private payor child health financing including the coverage and payment policies of commercial payers and government payors such as Medicaid and Medicaid MCOs. Partner closely with federal advocacy and state advocacy to address issues related to child health financing across Medicaid, state Medicaid programs and Medicaid Managed Care. Work with general pediatricians and pediatric medical and surgical subspecialists, to identify challenges, opportunities and solutions associated with implementation of AAP clinical policy recommendations. Develop and promote materials, financial models, and strategies to help members successfully negotiate with payers including alternative payment models.

DUTIES AND RESPONSIBILITIES:

1. Establish relationships with payers, national or regional business groups, and health plan associations to identify and leverage opportunities to promote the adoption of AAP policies, reports, recommendations, and clinical guidelines through appropriate payment policies.

2. Develop communication plans to address emerging/urgent policy changes that impact pediatric healthcare financing including issues impacting Medicaid payments and coverage. Utilize expert communication skills and knowledge of payer decision making processes to establish mechanisms to develop and sustain proactive payer engagement to address the needs of children and pediatric providers.

3. Provide primary staffing for COCHF, PAAC, and the Pediatric Council including agenda development, meeting planning, preparation and dissemination of minutes, budgets and administrative follow up and assisting Chairs in developing and implementing objectives and goals. Utilize virtual technology to support section activities as appropriate.

4. Manage editing, proofing, reference verification of policy manuscripts, manuals, educational products, promotional materials, and other documents of COCHF. Review content of in-progress publications for consistency with existing AAP policy. Secure/negotiate copyright releases and/or reprint permissions for tables and other materials as needed.

5. Contribute expert payer policy understanding to AAP payer advocacy efforts through collaboration with AAP federal advocacy staff on legislative and/or regulatory matters pertinent to AAP policy, including reviewing Federal Register notices related to proposed rulemaking and/or exploring the significance of AAP representation at federally sponsored hearings and meetings.

6. Maintain a deep understanding of the mechanics of healthcare finance, payer and provider operations and child and family and provider needs to analyze existing policies, identify gaps and opportunities, and make recommendations to modify or develop policies that benefit children, families and providers.

7. Assist in the development of mechanisms to promote alternative payment models, including for Medicaid, and to promote financially feasible and appropriate practice payment models, including value based payment models that are patient-centered and incorporate the key needs of members and other critical stakeholders.

8. Track trends in pediatric payment models and payer policies that impact pediatric healthcare finance and delivery. Create and disseminate information to members that informs them of updates related to healthcare finance and delivery.

9. Utilize AAP technological and personnel resources to help increase collaboration among members.

10. Coordinate with AAP state and federal advocacy staff to align efforts related to healthcare finance.

11. Work with the coding team to communicate changes in coding and other relevant information.

12. Help to identify and resolve trends identified through pediatrician submissions to the coding hotline.

13. Maintain liaisons with individuals from other relevant professional medical and non-medical associations.

14. Collaborate with practice management, quality, and other relevant areas within the AAP on how to incorporate healthcare finance into their outputs.

15. Perform other duties as assigned.

EDUCATION:

Bachelor’s degree in business, economics, or related discipline or an equivalent combination of relevant education and work experience required.

EXPERIENCE:

At least three year’s related experience working in provider relations or provider network development experience either within a payer or non-profit organization, or three years’ experience working as a payer consultant on payment methodologies or provider relations. Experience working with alternate payment models and/or value-based care preferred Knowledge of, and experience working with, government payors including Medicaid and Medicare managed care and fee for service payment methodologies preferred. Familiarity with federal and state regulatory agencies and official issuances, and payment policy enforcement and development protocols preferred. A deep understanding of the managed care industry preferred. Experience in health care or child health advocacy preferred.

ESSENTIAL SKILLS:

Ability to research, interpret, and project the foreseeable impact of pediatric related policy, coding, and payment changes by government and commercial payors. Familiarity with coding and payment issues as they pertain to pediatricians and family practice physicians. Excellent analytical, problem solving, organizational, and written/verbal communication skills required. Must be able to lead and be part of a team, take initiative, manage multiple priorities simultaneously, collaborate effectively with our members and various internal and external constituents, and promote and maintain a positive and cooperative team-oriented work environment with a commitment to equity, diversity, and inclusion. Ability to translate and communicate AAP child health financing policies to various stakeholders and create policy strategy preferred. Strong technical acumen essential with proficiency in MS Office (especially Excel) and the ability to learn and apply new technologies; experience with virtual meeting platforms (eg, WebEx) preferred. Some travel and evening/weekend work required.

Hybrid work environment of 40% of work time in the office per month.

All AAP employees must be fully vaccinated against COVID-19. Requests for a medical or religious accommodation in regard to this vaccination can be submitted for consideration upon an offer of employment.

To learn more about the organization, see a full job description, and/or apply for the position, please visit https://www.aap.org/employment.

The AAP offers an excellent work environment, competitive salary, and a comprehensive benefits package. As a reaffirmation to our employee-focused culture, since 2005 the AAP has been named one of the 101 Best and Brightest Companies to Work for in the Chicagoland area. Additionally, we are an Equal Opportunity Employer of Minorities, Females, Individuals with Disabilities, and Veterans that values the strength diversity brings to our workplace.

Reasonable Accommodation: Individuals with a disability in need of a reasonable accommodation regarding the job application process may call 630-626-6297. Please note, only those inquiries concerning a request for reasonable accommodation will receive a response.