Top Managed Care Executive plans and directs all aspects of an organization's managed care function. Responsible for directing and implementing managed care systems for healthcare facilities. Being a Top Managed Care Executive requires a bachelor's degree. Typically reports to a top management. The Top Managed Care Executive manages a departmental function within a broader corporate function. Develops major goals to support broad functional objectives. Approves policies developed within various sub-functions and departments. To be a Top Managed Care Executive typically requires 8+ years of managerial experience. Comprehensive knowledge of the overall departmental function. (Copyright 2024 Salary.com)
GENERAL SUMMARY:
Under minimal supervision of the Manager, independently leads financial and data analysis to evaluate rate proposals, contract terms, and health plan reimbursement. This position will proactively identify rates, methodologies, and processes that need improvement and will develop and implement solutions to optimize reimbursement.
PRINCIPLE DUTIES AND RESPONSIBILITIES:
1. Manage specific payor relationships for contracting purposes.
2. Lead the development of financial reporting and analysis using tools such as EPSi, SQL, Epic Clarity, and Power BI to extract and analyze data for the purpose of assessing contracted rates and reimbursement methodologies.
3. Generate proactive analysis and make recommendations to Contracting leadership based on review and identification of payer performance reporting trends.
4. Lead evaluation, and creation, of metrics and processes to improve and / or track rates against industry averages to identify gaps and areas for improvement.
5. Manage the rate review process for existing and proposed contracts to evaluate budgetary impact, verify that all necessary reimbursement terms are addressed, and the rates are depicted as negotiated.
6. Coordinate with contract modeling team the implementation and maintenance of contract management/pricing systems.
7. Maintain expertise in reimbursement methodologies, payer policies, and regulatory changes as they apply to payor contracts.
8. Manage and complete special projects and attends various meetings.
9. Coordinate and support Contracting projects for business units across the Health System
EDUCATION/EXPERIENCE REQUIRED:
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