The Director, Payment Advocacy, will serve at the conduit between the AOA, its members and private insurers. Reporting directly to the Senior Director, Physician Services, the Director will be responsible for managing and overseeing operational initiatives underway related to private insurers. The Director will be required to handle a large and diverse portfolio of work, which will involve simultaneously serving as an individual contributor, and a subject matter expert and resource for other teams and departments within the broader AOA/AOIA organization.
This position helps advance the mission of the AOA/AOIA and support the organizations’ member physicians by developing, assessing and enforcing policies, procedures and response processes that ensure all payment- and practice-related issues are addressed in an accurate, comprehensive and timely manner by the Physician Services Department. The Director will also develop and launch a strategic plan to ensure AOA members are acutely aware of and well informed on contemporary payment- or practice-related issues, which may include payment methodologies and delivery models; network contracting and participation; revenue cycle management; operating a private practice; patient engagement and population health; billing and collections; and coding and documentation.
Works directly with payors to influence policy decisions, advantageous payment reforms, and expanded coverage and access to physicians’ services; and helps ensure an optimal outcome for AOA members and DOs by directly advocating or directing advocacy efforts of subordinates as issues, disputes or opportunities arise.
Develops, maintains and continuously strengthens relationships with public and private payors, hospitals/health systems, medical groups and practices, and allied organizations or associations; and manages the design and implementation of strategic outreach initiatives to educate public and private insurers on the distinctive philosophy and practice of osteopathic medicine as well as the unique challenges faced by DOs in the payment and practice management realms.
Participates in the development of CME and non-CME programming for AOA/AOIA member physicians and their practices on a wide array of payment- and practice-related issues (e.g., coverage, reimbursement, payment reform, insurance industry operations, practice operations, medical coding, office billing, audits, utilization reviews).
Works collaboratively with internal teams and departments (e.g., Communications, Public Policy, Legal, Business Development) by providing subject matter expertise and insight-driven recommendations on AOA/AOIA issues from the Payor Relations or Practice Management arenas.
Helps craft, develop and refine the AOA’s positions on legislative, regulatory and private sector payment and practice management initiatives; and serves as liaison to outside stakeholders on a wide array of contemporary issues in health care financing policy and care delivery.
Regularly monitors industry trends and anticipate implications of changes on DOs and their practices; and translates and/or directs the translation of complex information into meaningful guidance, strategic advice and training materials for AOA members and other affiliated parties.
Supports AOA policy development and refinement activities by directly providing and/or working collaboratively with direct reports to provide payment- and practice-related information, materials and reports to the Bureau of Socioeconomic Affairs and the Bureau of Federal Health Policy.
As needed, attends or presents at meetings and events with AOA/AOIA members and other stakeholders; and reports out on meeting activities, outcomes and findings to the AOA’s Senior Leadership Team and AOA or AOIA Board members.
Handles and maintains highly confidential, proprietary and/or sensitive information.
Education: Bachelor’s degree and advanced degree required.
Experience: Minimum of five years of post-graduate experience in a health insurance company, medical practice hospital/health system or healthcare-related organization. Previous experience with professional and/or membership associations representing physicians.
Special skills: Strong subject matter expertise in health policy, payor relations, practice management and/or the business of medicine. In-depth understanding of the evolving payment landscape for physicians and the core methodologies employed under fee-for-service and value-based arrangements. Knowledge or awareness of topics closely related to those within Physician Services’ portfolio (e.g., board certification, CME and MOC requirements, legislative and regulatory issues of importance to medical students and practicing physicians). Demonstrated competence for assessing, addressing and proactively managing projects, issues and initiatives in a fast-paced environment. Keen attention to detail and capacity to work independently with minimal guidance and/or supervision.
Communications: Strong interpersonal skills with ability to work well in teams. Superior communications, organizational and problem-solving skills.
Travel: Domestic travel may be required (up to 25%).
Physical demands: Work is generally sedentary in nature, but requires occasional standing, walking, lifting and moving objects (up to 25 pounds). Requires manual dexterity to use office equipment.
Internal Number: 10058
About American Osteopathic Association
The AOA's mission is to advance the distinctive philosophy and practice of osteopathic medicine.
Serving as the professional family for more than 129,000 osteopathic physicians (DOs) and osteopathic medical students, the American Osteopathic Association (AOA) promotes public health and encourages scientific research. In addition to serving as the primary certifying body for DOs, the AOA is the accrediting agency for all osteopathic medical schools.