Additional Information About the RoleBJC has an opening for a Manager, Managed Care Systems. This role is responsible for ensuring Epic is accurately configured and maintained with managed care contract data. Ideally, candidates will have experience with Epic Resolute Hospital Billing, specifically RHB390 Expected Reimbursement Contract Administration.
OverviewThe
BJC Managed Care department includes multiple functions such as managed care contracting, financial analysis, systems and operations, value-based care and payment programs, payor and provider relations, and direct to employer solutions.
Preferred QualificationsRole PurposeResponsible for managing and supporting complex Contract Management Applications (CMA) to ensure that BJC Net Revenue is accurately reflected. Responsible for developing date access strategies to support contract negotiations, detailed financial analytics and special projects, including new payment methodologies. Partners with IT and vendors as it relates to the CMA and provides key support to the Revenue Cycle Management team. Participates in RCM team meetings providing expertise to help make decisions around processes, claims issues, mapping and edits that impact the CMA application.
ResponsibilitiesManages individual(s) including but not limited to: hires, trains, assigns work, manages & evaluates performance, conducts professional development plans. Ensures that the productivity and actions of that group meet/support the overall operational goals of the department as established by department leadership.May participate in the development of departmental staffing, revenue and/or expense budgets and having direct responsibility for adhering to those goals. This includes responding to changes in the business which may affect the ability to achieve the budget goals.Manages and leads the maintenance of day-to-day operations of the CMA including contract loads for all payers (including, but not limited to managed care, government, direct. etc.,) interfaces, data integrity, system enhancements and vendor relations, Facilitates the resolution of contractual, interface and calculation issues in a timely manner.Responsible for expert level application and knowledge transfer of the CMA. Reviews complex contract payment methodologies, offer suggestions for ease of administration and participates in the decision making process.Manages all data mining as it relates to the CMA to support contract negotiations, ongoing operations and special projects. This includes designing, developing and implementing complex databases and comprehensive reports to provide the data in the most accurate and efficient manner in support of organizational strategies.Maintains collaborative working relationships with Revenue Cycle Management leaders, Corporate Finance, Government Reimbursement teams and the vendor, effectively communicating issues, concerns and changes in a timely and appropriate manner.Provides leadership to the team of operational professionals responsible for loading complicated contract rate terms and for overseeing system application, performance and future viability.Minimum RequirementsEducationBachelor's DegreeExperience5-10 yearsSupervisor Experience< 2 years Benefits and Legal StatementBJC Total RewardsAt BJC we're committed to providing you and your family with benefits and resources to help you manage your physical, emotional, social and financial well-being.
- Comprehensive medical, dental, vison, life insurance, and legal services available first day of the month after hire date
- Disability insurance* paid for by BJC
- Annual 4% BJC Automatic Retirement Contribution
- 401(k) plan with BJC match
- Tuition Assistance available on first day
- BJC Institute for Learning and Development
- Health Care and Dependent Care Flexible Spending Accounts
- Paid Time Off benefit combines vacation, sick days, holidays and personal time
- Adoption assistance
To learn more, go to our Benefits Summary*Not all benefits apply to all jobs
The above information on this description has been designed to indicate the general nature and level of work performed by employees in this position. It is not designed to contain or be interpreted as an exhaustive list of all responsibilities, duties and qualifications required of employees assigned to this job.
