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)
Maintain and update Epic and contract management tool (e.g. Strata Jazz) as it relates to contract management and maintenance, be the Subject Matter Expert (SME) for both systems as it relates to contract build.
Troubleshoot and fix Epic and contract management tool as it relates to incorrect contract logic causing claims to process incorrectly; submit help tickets requesting assistance from Epic or contract management tool to correct issues.
Update the team as to accuracy of Epic and contract management tool functionality; develop and maintain contract variance reports for contract inconsistencies.
Knowledge of payor contracting methods and reimbursement processes, particularly as they relate to claim payment and operational administrative issues.
Responsible for updating billing teams with contract documents and being the liaison between Billing and Managed Care.
Develop and maintain reporting and modeling capabilities in both Epic and contract management tool and ensuring both systems are operating at full capacity. Participate in system meetings as offered to learn about new upgrades to systems.
Run ad hoc reports and complete impact analysis as requested. Provide back up support to Business Data Analyst as assigned.