Payment Reform Consultant

POSITION SUMMARY

The Payment Reform Consultant works closely with the Senior Director of Payer and Financial Strategy to support the implementation of Michigan’s Prospective Payment System (PPS) Alternative Payment Methodology (APM). The Payment Reform Consultant works with all stakeholders to provide educational sessions, develop and convene meetings, and demonstrate the program’s impact and value. They design strategies to optimize the continued transition away from fee-for-service to innovative payment and clinical models that improve health outcomes and financial sustainability; actively research reimbursement innovations and monitor the current landscape of Michigan and Federal payment and clinical models.

RESPONSIBILITIES AND DUTIES

1. Oversees and supports implementation and evolution of Michigan’s PPS APM.
2. Proactively coordinates key stakeholder meetings and trainings for PPS APM including creating times that work, drafting agendas, and preparing and editing meeting minutes and presentations.
3. Oversees the content development of events and trainings, webinars, facilitation of peer-to-peer networking, and provision of resources, as needed, to enhance PPS APM knowledge.
4. Maintains and manages the project calendar, including all contact lists.
5. Leads development of program communication and contributes to coordination and integration of external communication pertaining to PPS APM in order to improve program effectiveness and promote member engagement.
6. Contributes to the development and maintenance of member relations and knowledge management tools.
7. Responsible for internal documentation and tracking of program progress.
8. Act as a thought partner on new program strategy and design in order to promote alignment, coordination and integration across programs, and ensure effectiveness of implementation plans and advancement of organizational priorities.
9. Monitors external program and policy developments in complex innovation, integration, and social determinants of health landscapes.
10. Leads and manages work requiring innovative solutions and high levels of detail and complexity, with MPCA and health center staff.
11. Supports modeling and analysis of various APM model decision points (services included, baseline years, etc.)
12. Oversees and conducts financial impact analysis and projections, working with contractors as appropriate, on items such as independent rate validation for the APM.
13. Reviews and develops comments and recommendations on DHHS state plan amendments, policies, and manual documentation related to APMs.

KNOWLEDGE, SKILLS AND ABILITIES

Requires Knowledge of:

• Michigan’s health coverage landscape including common public and private payers.
• Michigan’s health and human services infrastructure
• Michigan’s Medicaid program
• Federally Qualified Health Center Reimbursement
• Value Based Care concepts and models.

Skill/Ability to:

• Strong interpersonal communication skills with the ability to tactfully and effectively communicate complex and technical information, both written and verbal, in a professional manner that supports the ability to establish and maintain effective working relationships across all levels of MPCA and external stakeholders.
• Strong organizational skills, the ability to prioritize, and the ability to coordinate multiple projects with minimal supervision.
• Ability to work in team settings to show flexibility and versatility.
• Ability to learn additional software applications.
• Ability to self-motivate and thrive in a complex and rapidly changing environment.
• Ability to work with strict confidentiality requirements, as well as utilize good judgment in the preparation and distribution of confidential information.
• Ability to collect, analyze, compile and interpret technical and/or statistical data
• Ability to develop a plan of action and assume accountability for outcomes when working with Health Center partners or other stakeholders.

Education/Experience:

• Bachelor’s degree in a relevant field such as public health, health policy, healthcare administration, business administration, and/or a relevant combination of education and work experience. Master’s degree preferred.
• At least one year of professional experience working in healthcare (revenue cycle, finance, managed care, service delivery/practice transformation, etc.), a health and human services organization, or a closely related field required, three or more years preferred.