As the Director, Technology, Coding and Pricing Group, you will provide executive direction for the consideration of new technologies and their treatment in the Medicare program. You will lead the development and evaluation of national Medicare policies and standards on certain benefit structures and payment methods; the maintenance of medical coding systems; and the assessment of applications for special payment consideration for new technologies under several payment systems.
Responsibilities
- Develop and evaluate national Medicare policies and principles for payment of new technologies for various provider types under prospective payment systems.
- Develop methodologies to adjust payments based on statutory and regulatory criteria.
- Develop, evaluate and review payment and benefits policies, regulations and instructions concerning durable medical equipment, prosthetics, orthotics and supplies items and services.
- Develop, evaluate and review policies, regulations, requests for codes, and instructions concerning HCPCS and ICD-10 coding.
- Develop, evaluate and issue data collection methods for clinical laboratory services and part B drug average sales price (ASP). Calculate payment amounts based on the collected data as required by regulation and statute.
- Oversee ambulance payment policy and required cost data collection for ground ambulance providers and suppliers.
- Oversee the data analysis contract used to monitor DMEPOS competitive bidding and other payment system assessment topics to support ongoing policy changes and monitor the impact of such changes.
- Maintain continuing liaison with provider groups, industry associations, patient organizations, medical associations, and other stakeholders that relate to Medicare benefits.
- Evaluate applications for new technology payment status under the inpatient and outpatient hospital prospective payment systems and the End Stage Renal Disease prospective payment system.
