Manager, Managed Care - Systems

Additional Information About the Role BJC 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. Overview BJC HealthCare is one of the largest nonprofit health care organizations in the United States, delivering services to residents primarily in the greater St. Louis, southern Illinois and southeast Missouri regions. With net revenues of $6.3 billion and more than 30,000 employees, BJC serves patients and their families in urban, suburban and rural communities through its 14 hospitals and multiple community health locations. Services include inpatient and outpatient care, primary care, community health and wellness, workplace health, home health, community mental health, rehabilitation, long-term care and hospice. BJC is the largest provider of charity care, unreimbursed care and community benefits in the state of Missouri. BJC and its hospitals and health service organizations provide $785.9 million annually in community benefit. That includes $410.6 million in charity care and other financial assistance to patients to ensure medical care regardless of their ability to pay. In addition, BJC provides additional community benefits through commitments to research, emergency preparedness, regional health care safety net services, health literacy, community outreach and community health programs and regional economic development. BJC’s patients have access to the latest advances in medical science and technology through a formal affiliation between Barnes‑Jewish Hospital and St. Louis Children’s Hospital with the renowned Washington University School of Medicine, which consistently ranks among the top medical schools in the country. The 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 Qualifications Role Purpose Responsible 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. Responsibilities Manages 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, offers 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 Requirements Education: Bachelor’s Degree Experience: 5‑10 years Supervisor Experience: Benefits and Legal Statement BJC Total Rewards At 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, vision, 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 *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. Equal Opportunity Employer #J-18808-Ljbffr Academy of Managed Care Pharmacy