Executive Director, Medicare Policy




At the direction of the Vice President, Medicare Policy, and working closely with the Senior Vice President, Federal Programs, provides policy analysis and expertise on the Medicare Advantage and Part D programs, as well as the Medicare fee-for-service program, as needed in support of America’s Health Insurance Plans operating departments and member organizations as well as congressional staff and other policymakers.  Responsibilities include performing and assisting in designing quantitative analyses of Medicare program trends; developing background analysis and information that contributes to policy development; preparing concise analyses of key issues; closely monitoring and analyzing federal legislative initiatives, health policy developments, and federal agency policies; and pursuing other duties in support of America’s Health Insurance Plans’ advocacy efforts.

Essential Functions

Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

  1. Participates in America’s Health Insurance Plans government relations efforts relating to the Medicare Advantage and Part D programs as well as the Medicare fee-for-service program as needed. Contributes to the development of strategies to best serve member goals.
  2. Performs and assists in designing quantitative analyses of trends in the Medicare program, including Medicare Advantage county rates and Medicare Advantage and Part D enrollment, benefits, Medicare Advantage and Part D plan performance on the CMS Star Ratings System, Medicare enrollment and claims data, and other program trends to further AHIP’s goals, using spreadsheet analysis and other programming tools as necessary.
  3. Supervises outside research projects in support of AHIP’s advocacy.
  4. Develops background analysis and information to ensure that AHIP positions are properly presented and assists in development of appropriate strategies to further AHIP objectives.
  5. Provides concise written analyses of proposed legislation and health policy reports and assists in evaluating their impact on the industry. Assists in the preparation of testimony, position statements, and talking points for dissemination to the appropriate legislative and regulatory bodies and other interested parties concerning legislation, regulations, policies, published reports, and statutes governing public programs.  Prepares written reports, memos, and policy briefs that are sent to AHIP’s members.
  6. Communicates concise and clear descriptions of key issues to AHIP member plans and staff, including at the weekly Medicare Strategy meeting and on regular Medicare Policy Work Group conference calls. Responds to members’ questions on Medicare issues and related requests for materials.   Presents and explains the industry’s position to ensure that it is properly understood and considered.
  7. Provides substantive policy and operational updates from CMS and facilitates question and answer discussions with members as leader of regular conference calls, including the RADV Audit Work Group and the MA and Part D Data Reporting Work Group. Responds to members’ questions, and follows up with appropriate CMS staff as necessary to obtain more information or clarification on the content and timing of current and future guidance.
  8. Collaborates with members of the AHIP legal department and others in the development of AHIP amicus briefs on or involving issues related to Medicare Advantage.
  9. Represents AHIP as a Medicare Advantage and Part D subject matter expert on technical, multi-stakeholder industry collaborations, such as the Pharmacy Quality Alliance (PQA) Risk Adjustment Advisory Panel.
  10. Closely monitors and contributes policy expertise to government relations efforts relating to Congress, the U.S. Department of Health and Human Services (HHS), Centers for Medicare & Medicaid Services (CMS), Medicare Payment Advisory Commission (MedPAC) and other governmental agencies and commissions.
  11. Keeps informed of the continuous and rapid changes in the health care sector and congressional and regulatory activities which may have an impact on health insurance plans, particularly Medicare health plans.
  12. Maintains ongoing and close contacts with other America’s Health Insurance Plans staff to share or obtain information.
  13. Assists in developing AHIP’s policy and advocacy with respect to Medicare Advantage and Part D risk adjustment, encounter data, and related program operational and data issues. Organizes meetings and conference calls and drafts comments on regulations, guidance and other actions as necessary and appropriate for such tasks.
  14. Performs other tasks as required or assigned.


  1. Quantitative skills with minimum of five years of experience working with Excel required and knowledge of other advanced statistical programs such as Microsoft Access preferred.
  2. Understanding of the Medicare Advantage program required. Understanding of the Part D program preferred.
  3. Effective communication skills with experience providing oral and/or written summaries of health policy-related materials.
  4. Demonstrated capability to develop and maintain access to reliable sources of information in policy or advocacy-related settings.
  5. Knowledge of the techniques and methods of developing and executing policy analysis and an ability to deal with complex and changing political situations.
  6. Demonstrated good judgment, a well-developed sense of propriety, political acumen, the ability to think constructively, strong interpersonal skills, and a strong work ethic.
  7. Knowledge of the structure and functioning of the government and knowledge of current policy issues affecting AHIP and its member organizations with minimum of one year of experience.
  8. Experience performing data and policy analyses and applying them to serve advocacy goals.

Supervisory Responsibility

This position has no supervisory responsibility.

Work Environment

This job operates in a professional office environment. This role routinely uses standard office equipment.

Physical Demands

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job.

While performing the duties of this job, the employee is regularly required to talk or hear. The employee frequently is required to stand; walk; use hands to finger, handle or feel; and reach with hands and arms. Specific vision abilities required by this job include close vision, distance vision, color vision, peripheral vision, depth perception and ability to adjust focus.

Position Type/Expected Hours of Work

This is a full-time position.  Standard days and hours of work are Monday through Friday, 8:30 a.m. – 5:30 p.m., however may require long hours and weekend work.



Required Education and Experience

  1. Masters of Public Policy or Other Comparable Advanced Degree
  2. At least five years of experience performing quantitative analyses of health care issues and writing concise and timely evaluations of legislation and other related items.
  3. Experience providing policy expertise in an advocacy organization or equivalent experience.

Other Duties

Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities and activities may change at any time with or without notice.

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