Job Description

Job Description

Job Description

Description:

The primary duty of the Operational Policy Consultant (OPC) is to support federal contracts related to healthcare policy, operational changes, and program integrity. The OPC will research and analyze the impact of legislative and regulatory trends and develop operational materials, conduct audit activities, support the operation of appeals, and facilitate outreach activities and program evaluation concepts that will best meet the needs of ARDX’s clients. The OPC has strong knowledge of US regulatory and legislative healthcare policy governing federal healthcare programs (i.e., Medicare, Affordable Care Act (ACA), Medicaid) and private insurance. The OPC tracks the impacts of policy changes and applies implications to current processes and serves as a partner and strategist with limited supervision for solutions to complex challenges.

Key duties:

• Review healthcare policy and guidance documents and interprets documents into operational guidance to support audits and appeals.
• Interpret program/client/policy needs and requirements to serve as a trusted advisor to clients.
• Apply knowledge of audit or appeals in support of client.
• Perform non-critical roles independently and requires management (or higher-level consultant) assistance, guidance, or oversight with critical functions to anticipate outcomes and critical next steps for solutions and delivery accuracy.
• Usher efficiencies to reduce burden in processes.
• Perform peer reviews of client deliverables in accordance with customer requirements, style guides, and Quality Management System (QMS) requirements.
• Perform risk management activities to mitigate client concerns, as appropriate.
• Research, understand, and develop meaningful guidance in the form of training materials, job aids, manuals, and operational documents for internal and external use.
• Maintain awareness of current policy and regulations and proactively identify downstream impacts and solutions.
• Draft and update policy and operational documentation including standard operating procedures (SOPs) and contribute to White Papers.
• Bridge the gap between policy and operations by effectively recommending appropriate and innovative solutions for issues and challenges.
• Conduct research to gain an understanding of client’s business to inform decision making.
• Develop recommendations for improvements and effectiveness including business process optimization, by utilizing resources, such as evaluation surveys, dashboards, etc. Assess pros and cons of possible strategies and offer meaningful solutions.
• Manage assigned policy regulations governing assigned project contract.
• Maintain the Project Management Log (PML) including identification of risks and issues.
• Mitigate risks to quality delivery, performance, and customer satisfaction.
• Utilize project management methods and tools, including the ARDX Project Management Toolkit, to keep projects on track.
• Manage and report project performance measures.
• Follow quality procedures, SOPs, and job aids to ensure the accuracy, quality, and timeliness of all deliverables.
• Process inquiries including developing meaningful categorizations and responses to policy questions.
• Provide timely and accurate updates to internal reports including the service level agreement (SLA) and Closeout Reports.
• Contribute to innovation and contract growth by developing concepts for customer recommendations.
• Perform other duties as assigned.

• Bachelor’s degree in Public Health, Healthcare Administration, Business, or Public Administration; Master's degree preferred
• 5-7 years of healthcare working experience
• Technical writing experience
• Ability to conduct independent research
• Outstanding written and oral communication skills
• Well-developed analytical skills
• Ability to meet deadlines in a fast-paced environment
• Proficiency in using Microsoft Office applications such as Word, Excel, PowerPoint, and Outlook
• Project management experience; Project Management Professional (PMP®) certification a plus
• Experience with federal healthcare programs (Medicare, ACA, and Medicaid) desired
• Experience with federal government contracting desired
• Experience in a client-facing consulting role desired
• Curriculum development experience desired
• Experience with healthcare audits and appeals a plus
• Experience with Jira and Confluence a plus
• Experience with ISO and/or CMMI a plus

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