Management and Program Analyst

Summary

Job Title

Manage provider reimbursement policy and medical benefit programs for over 9 million TRICARE beneficiaries worldwide, with particular emphasis on value-based care initiatives, alternative payment models, and specialized demonstration projects.

Independently research, draft, and finalize authoritative, executive-level policy deliverables, including regulatory actions, legislative proposals, Department-level policy memoranda, Congressional responses, and contract modifications.

Utilizing large claims datasets, prospective payment systems, and industry-standard coding taxonomies (e.g., ICD-10, CPT, HCPCS, DRGs) to assess private sector program effectiveness and identify systemic healthcare cost and quality drivers.

Provide expert consultation and authoritative guidance to health care contractors on program medical benefit policy and reimbursement principles, policies, regulations and instructions.

Collaborate with interagency and private-sector partners (including CMS, VA, and commercial health insurers) on novel approaches to private sector health care delivery.

Serve as a key technical advisor to leadership and external authorities (such as the Department of Justice and GAO) on complex healthcare medical benefit policy and provider reimbursement.

Job Description

Job Title

Manage provider reimbursement policy and medical benefit programs for over 9 million TRICARE beneficiaries worldwide, with particular emphasis on value-based care initiatives, alternative payment models, and specialized demonstration projects.

Independently research, draft, and finalize authoritative, executive-level policy deliverables, including regulatory actions, legislative proposals, Department-level policy memoranda, Congressional responses, and contract modifications.

Utilizing large claims datasets, prospective payment systems, and industry-standard coding taxonomies (e.g., ICD-10, CPT, HCPCS, DRGs) to assess private sector program effectiveness and identify systemic healthcare cost and quality drivers.

Provide expert consultation and authoritative guidance to health care contractors on program medical benefit policy and reimbursement principles, policies, regulations and instructions.

Collaborate with interagency and private-sector partners (including CMS, VA, and commercial health insurers) on novel approaches to private sector health care delivery.

Serve as a key technical advisor to leadership and external authorities (such as the Department of Justice and GAO) on complex healthcare medical benefit policy and provider reimbursement.