Quality Payment Specialist

Overview

The core responsibility of this position is the oversight of FHP’s performance under CMS’s Quality Payment Program (QPP), Alternative Payment Models (APMs), and other regulatory value based programs. Provides oversight to the incentive payment programs impacting both eligible providers (EP) and eligible hospitals (EH). Establishes system-wide processes that meets requirements and monitors performance on the incentive metrics. Collaborates with Finance and Quality Departments for attestation or submission to the appropriate governmental agencies. Facilitates ongoing strategy and education on meeting the requirements of QPPs to all impacted employees, providers, and leadership.

Responsibilities

• Partners with Finance and other key stakeholders to continually monitor and analyze financial reimbursement trends and healthcare changes within the national and Alaska marketplace. Analyzes the market as it relates to provider incentive programs. Evaluates the impact to Foundation Health and works collaboratively with key stakeholders to determine the appropriate approach related to CMS’s QPP or other payor’s value based programs.
• Serves as FHP’s subject matter expert on CMS QPP programs for both hospital and providers. Stays current with all related regulation changes, and understands their impact on operations, finance, as well as any needed EMR configurations or applications. Advises FHP leadership and stakeholders to the changing regulations and the identification of any major organizational process impacts.
• Collaborates with key stakeholders to establish workflows and processes for strong reimbursement or decreased penalties with operational, clinical and financial leadership. Ensures clear accountability for success, optimizing maximum incentives and minimizing penalties. Facilitates consensus for workflow standardization as necessary.
• Partners with educational and communication business owners across the system to communicate initial decision, workflows, and processes along with initial and ongoing education for employees, providers and leadership.
• Facilitates the eligible hospital and eligible provider performance on metrics tied to incentive programs. Creates and manages associated performance dashboards. Creates and implements appropriate action plans to meet targets, as needed. Partners with Clinical Informatics, clinical leaders, and physicians to optimize workflows to meet program measures. Includes the development of project plans, charters, and the organization of cross functional teams.
• Assists the Finance and Quality Departments with the submission of results to the appropriate governmental agencies.
• Proactively identifies regulation changes that will require EMR or other software changes, advising Information Technology and Finance of the needs in advance with budget timing in mind. Partners with IT for necessary software system set up and data migrations. Generates reports and communicates with IT for any data reporting needs.

Qualifications

• Requires extensive sitting with periodic standing and walking.
• May be required to lift up to 20 pounds.
• Requires significant use of personal computer, phone and general office equipment.
• Needs adequate visual acuity, ability to grasp and handle objects.
• Needs ability to communicate effectively through reading, writing, and speaking in person or on telephone.
• May require off-site travel

Preferred Qualifications

• Additional related education and/or experience preferred.