Job Description

MISSOURIEN

CLASSIFICATION SPECIFICATION

CLASS TITLE:MANAGED CARE REIMBURSEMENT SPECIALISTSUPERSEDES:Managed Care Specialist (6/00), 11/16

CODE: 6019 REVISED: 01/2019

BASIC FUNCTION AND RESPONSIBILITY

Responsible for complex analytical support for a wide range of managed care initiatives, including; contract negotiations, contract modeling in the hospital's decision support/contract management system, fee schedule analysis, managed care contract and other payor performance reporting, and other initiatives related to payor reimbursement and incentives.

CHARACTERISTIC DUTIES

Responsible for financial modeling and analysis of all managed care payment proposals. This includes preparation of contract history and performance reports, contract segmentation analysis, impact reports of various contract structures and rates, and consultation of key reimbursement drivers in the models to assist in contract negotiation process.

Responsible for creating and managing facility contract models within the Decision Support/Contract Management system. This includes implementing final negotiated rates in the decision support/contract management system, updating the contract for fee schedule updates, performing other ongoing maintenance to ensure accurate expected reimbursement calculations. Key team member in the overall management of Decision Support/Contract Management System; this includes participating in decisions regarding installations, upgrades, testing and maintenance. Provides input to the vendor about functional design, data components, and other parameter and use that impact the efficiency and accuracy of the modeling tools.

Produces monthly and complex quarterly managed care/payor report that include payor performance, payor mix, payor trends, service line analysis, and business trend analysis.

Develops and provides ad-hoc reporting for special data accumulations, studies, and projects requested by internal management or other external sources as necessary. Projects include but are not limited to: payor contract summary detail information for bond rating requests, preparation of year-end contractual allowance estimates for various third- party payors, and support for Center of Excellence surveys.

SUPERVISION RECEIVED

Direction is received from an assigned manager/supervisor.

SUPERVISION EXERCISED

No supervision is exercised.

MINIUMUM QUALIFICATIONS

Bachelor's degree is required, preferably in Business Administration, Information Technology, Finance or Statistics. Requires five or more years experience in hospital contract financial analysis or hospital finance; including a thorough understanding of payor contracts, payor reimbursement, payor manuals, and reimbursement policies. Experience within an academic medical center is highly desirable.

KNOWLEDGE, SKILLS & ABILITIES

Strong analytical and problem-solving skills; including the ability to research and analyze financial/operational information and to translate complicated data into useable knowledge. Accuracy and attention to detail is a must as the contracts and projects involve millions of dollars. Excellent interpersonal, written and verbal communication and presentation skills. High proficiency in decision support applications Advanced skills in Microsoft Office applications such as Excel, Access, Word, and Outlook.

PHYSICAL DEMANDS

The physical demands described here are representative of those that must be met with or without reasonable accommodation. The performance of these physical demands is an essential function of the job. The employee may be required ambulate, remain in a stationary position and position self to reach and/or move objects above the shoulders and below the knees. The employee may be required to move objects up to 10 lbs.

This document is a general description of typical job duties, responsibilities and qualifications of employees holding the associated job title. Additional duties, specific qualifications and work emphasis may vary between individual positions.

MANAGED CARE REIMBURSEMENT SPECIALIST 6019

March 3, 2026

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PERFORMANCE EXPECTATIONS

This job description is not designed to cover or contain a comprehensive listing of activates, duties or responsibilities that are required of the employee for this job; however, completion of these duties is a measure of successful performance. Employees of this job classification are subject to quarterly performance reviews. Basic function, responsibilities and characteristics duties may change at any time with or without notice.