Health Policy Reimbursement & RUC Consultant

Organization Overview  

The American Academy of Pediatrics (AAP) is a professional membership organization of 67,000 pediatricians committed to the optimal physical, mental, and social health and well-being for all infants, children, adolescents and young adults.   

Founded in 1930, the AAP advocates for the health and wellbeing of all children and works with government, communities and other national organizations to shape many child health and safety issues. The AAP provides professional education and resources to member pediatricians, and provides patient education and public information campaigns. 

The AAP supports the development and sustainability of a quality health care delivery system for children. This includes advocacy for adequate coverage of services for children and adequate payment to health care providers including participation in the American Medical Association’s (AMA) specialty society Resource-Based Relative Value Scale Update Committee (RUC) to support the Medicare relative values and provides recommendations to CMS.  

Project Background 

The successful bidder will provide consultant services to conduct the coding valuation activities of the Pediatric Health Care System and Payment Transformation team within the AAP Primary Care and Subspeciality Pediatrics department related to the AMA RUC.  

Utilizing knowledge of pediatric primary and subspeciality care practice and delivery systems, the consultant will staff and manage the AAP coding and physician payment activities related to the RUC, collaborate with specialty society RUC staff including society RUC consultants, manage the RUC survey process including generation of AAP member sampling methodologies, survey data analysis, recommendations to the RUC, and other activities to support the code valuation processes of the AAP’s participation in the RUC. 

Summary of Work – Specifications   

• Manage the processes related to AAP’s participation in the AMA RVS Update Committee (RUC)
• Meet with AAP RUC advisors to prepare for RUC meetings (variable frequency based on needs)
• Attend all scheduled (at least weekly) RUC staff meetings
• Meet regularly with AAP coding staff and /or SVP
• Attend precipitation and facilitation meetings according to the AMA facilitation meeting schedule to be determined based on the needs of specific code valuation activities
• Identify subject matter experts to assist RUC advisors, as needed, during RUC meetings and RUC meeting preparation
• Coordinate AAP survey sample development
• Deploy RUC surveys to chosen statistical sample
• Perform survey data analysis and management
• Coordinate the AAP RUC team for the development of recommendations to the RUC in collaboration with other specialty society RUC staff
• Coordinate with multispecialty AAP staff to develop consensus recommendations, processes and logistics for RUC meeting preparation
• Respond to the needs of pediatric primary care and subspeciality providers to advocate for appropriate payment for pediatric health care services through the RUC process and other AAP payer policy activities  
• Collaborate with AAP member leaders and staff on the development of public comment letters and responses to proposed rules and other federal payment policy changes
• Coordinate meeting logistics, develop agendas, and manage AAP RUC team meetings
• Travel to the RUC meetings to locations specified in the RUC calendar

Scope of work  

The schedule of deliverables aligns with the published AMA RUC calendar and includes but it not limited to administering RUC surveys, making recommendations to AAP and other society RUC staff regarding RUC summary recommendations, and public comment letters when solicited by CMS.  

Project Timeline  

6-month assignment. 

Mandatory Skills 

• At least 2 years of experience working with the RUC processes 
• Knowledge of pediatric primary and subspecialty care
• Ability to advocate for sustainable and adequate pediatric coding valuation 
• Excellent written and verbal communication skills
• Ability to work both independently and as part of a team, and show diplomacy when faced with challenging situations and differences of opinion/competing priorities of members of a group
• Proficient with Microsoft Office Suite, specifically Excel and familiarity with virtual meeting platforms (WebEx, Teams, Zoom)
• Ability to work with large databases, analyze and interpret survey data and to communicate results to multiple audiences 
• Maintain a positive and cooperative team-oriented work environment with a commitment to equity, diversity, and inclusion

Responses Format 

Please submit a bid that includes the following to Roberta Bosak at rbosak@aap.org. Responses will be reviewed beginning June 9, 2023.  

• Name and contact information of key personnel expected to perform the work
• Experience and qualifications of key personnel expected to perform the work
• Three (3) professional references
• Budget 

Please submit a bid that includes the following to Roberta Bosak at rbosak@aap.org. Responses will be reviewed beginning June 9, 2023.  

• Name and contact information of key personnel expected to perform the work
• Experience and qualifications of key personnel expected to perform the work
• Three (3) professional references
• Budget