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Fee Schedule Analyst, Governmental Engagements

3 months ago

New York, United States FAIR Health Inc Full time
Job DescriptionJob Description

About FAIR Health

FAIR Health, Inc., a national, independent nonprofit organization, was established in October 2009 with the mission to help assure fairness and transparency in health insurance information. FAIR Health has created a database of over 46 billion de-identified commercial healthcare claim records-the largest in the country-which receives claims monthly and which serves as the foundation for a variety of data products, custom analytics and consumer tools. FAIR Health has also been certified by the Centers for Medicare & Medicaid Services as a national 'Qualified Entity' and thus holds the entire collection of Medicare Parts A, B and D claims from 2013 to the present, which get routinely refreshed.

Our standard data modules, custom analytics and technological tools serve all participants in the healthcare sector nationwide; they are licensed to payors, third-party administrators, bill review companies, self-insured employers, government agencies, academic researchers and consultants. Our medical and dental data are used to inform statutes and regulations, healthcare cost indices, fee schedules, benefit and provider network design, practice/facility expansion, health systems research and dispute resolution, among other uses. We also offer a suite of consumer-oriented tools and resources available on our consumer website (fairhealthconsumer.org), as well as a mobile application, which can be licensed by other organizations.

Summary of Position

The FAIR Health Governmental Engagements team assists federal and state government agencies with their healthcare data needs. The primary focus of this position is developing, updating, distributing and ongoing management of fee schedules for workers' compensation, auto liability (personal injury protection), crime victim funds, vocational rehabilitation and other specialized needs.

New fee schedules are developed and existing fee schedules updated to incorporate new procedures, reflect changes in laws, regulations and coding practices, update payment guidelines and review and update rate tables. FAIR Health provides support to create consensus among diverse stakeholders and reflect the needs and characteristics of the state jurisdictions.

The person in this Governmental Engagements position is responsible for working with state and federal agencies to help them evaluate information to meet their needs. Responsibilities include responding to requests for proposals (RFPs), supporting the agency's development of policy through data and knowledge of other state fee schedules, developing payment guidelines and rate recommendations, meeting with state officials, presenting information and collecting feedback at stakeholder meetings. In addition, the individual will develop comparative analytics based on state data, CMS fee schedules, private health insurance cost information and other state fee schedules. Working with data analysts, clinical experts and other members of the Governmental Engagements team, the incumbent will develop rates, update payment guidelines, synthesize stakeholder feedback and format and QA fee schedules.

Primary Responsibilities

  • Leads state and federal fee schedule engagements.
  • Supports team members leading fee schedule projects for other states.
  • Works with states to understand their fee schedule needs.
  • Writes responses to requests for proposals (RFPs).
  • Manages the information gathering process with state agency clients.
  • Meets with state officials to formulate an approach to fee schedule development.
  • Provides consultative support to state officials.
  • Engages in ongoing communication with agency officials (pre- and post-contract).
  • Analyzes paid data and develops comparative analyses.
  • Directs data analyst activities, which may include recreating current fee schedules, modeling proposed fee schedules based on alternative methodologies and preparing communications to state officials.
  • Develops recommendations on structure and fee schedule rates.
  • Synthesizes and packages clinical research for presentation to state officials.
  • Develops fee schedule rate tables and payment guidelines.
  • Oversees detailed editing and QA of the fee schedules.
  • Participates in stakeholder meetings, including presentations of proposed changes.
  • Assists agency staff with questions relating to the fee schedule.
  • Manages annual maintenance and updates.
  • Attends conferences and supports business development efforts.
  • Monitors and tracks state workers compensation program legislation and trends.

Knowledge and Skill Requirements

  • Bachelors degree or equivalent work experience in healthcare policy, data, workers compensation, government fee schedules or a relevant field.
  • Medical and dental insurance billing/coding and clinical knowledge to support fee schedule development.
  • A minimum of five years proven experience in a governmental agency working with fee schedules, health or property and casualty insurance, healthcare consulting or in an industry practitioner role.
  • Interpersonal skills to build and nurture client relationships.
  • Analytical and problem-solving abilities.
  • Ability to develop professional-level presentations based on clinical research and data analysis.
  • Flexibility to manage multiple concurrent projects and shifting time frames.
  • Knowledge of workers compensation regulations, legislation and processes a plus.
  • Strong project management skills to meet tight timelines and complex deliverables.
  • Outstanding verbal and written communication skills.
  • PowerPoint and Excel skills.
  • Solid analytical, problem solving and team management abilities.

Location: Ability to work from the companys New York City office or remote.

Salary range: $95k $130k

Interested candidates should submit their resume to resumes@fairhealth.org.

FAIR Health, Inc., is an equal opportunity employer and is an E-Verify participant.

All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity or national origin.

FAIR Health offers a competitive compensation package and includes the following benefits: Medical, Dental, Vision, Flexible Spending and Dependent Care Accounts, Life and Disability Insurance, Paid Time Off, Paid Holidays, 401(k) and Discretionary Bonus.

Company DescriptionFAIR Health, Inc., an independent nonprofit organization, was established in October 2009 with the mission to help ensure fairness and transparency in health insurance information. FAIR Health has created a database of over 28 billion de-identified private healthcare claims—the largest in the country—which receives claims monthly and which serves as the foundation for a variety of data products, custom analytics and consumer tools. FAIR Health has also been certified by CMS as a “Qualified Entity” and thus holds the entire collection of Medicare Parts A, B and D claims from 2013 to the present which get routinely refreshed.
Our standard data modules, custom analytics, and technological tools serve all participants in the healthcare sector nationwide; they are licensed to payors, third-party administrators, bill review companies, self-insured employers, government agencies, academic researchers, and consultants. Our medical and dental data are used to inform statutes and regulations, healthcare cost indices, fee schedules, benefit and provider network design, practice/facility expansion, health systems research, and dispute resolution among, other uses. We also offer a suite of consumer-oriented tools and resources available on our consumer website (fairhealthconsumer.org), as well as mobile applications which can be licensed by other organizations.Company DescriptionFAIR Health, Inc., an independent nonprofit organization, was established in October 2009 with the mission to help ensure fairness and transparency in health insurance information. FAIR Health has created a database of over 28 billion de-identified private healthcare claims—the largest in the country—which receives claims monthly and which serves as the foundation for a variety of data products, custom analytics and consumer tools. FAIR Health has also been certified by CMS as a “Qualified Entity” and thus holds the entire collection of Medicare Parts A, B and D claims from 2013 to the present which get routinely refreshed.\r
Our standard data modules, custom analytics, and technological tools serve all participants in the healthcare sector nationwide; they are licensed to payors, third-party administrators, bill review companies, self-insured employers, government agencies, academic researchers, and consultants. Our medical and dental data are used to inform statutes and regulations, healthcare cost indices, fee schedules, benefit and provider network design, practice/facility expansion, health systems research, and dispute resolution among, other uses. We also offer a suite of consumer-oriented tools and resources available on our consumer website (fairhealthconsumer.org), as well as mobile applications which can be licensed by other organizations.