City/State: Saint Louis, Missouri
Categories: Leadership
Job Status: Full-Time
Req ID : 104733
Pay Range: $8.00 - $500,000.00 / year (Salary or hourly rate is based on job qualifications and relevant work experience)
Additional Information About the Role
Additional Preferred Requirements
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
This role is responsible for Managed Care Finance and Analytics. Managed Care Finance-encompassing reimbursement analytics, advanced contract modeling, and strategic reimbursement-is a mission-critical function for BJC. These capabilities form the analytical foundation for all managed care agreements and directly support negotiations tied to billions of dollars in annual reimbursement.
Responsibilities
Manages individual(s) including but not limited to: onboarding and hiring, training, workload management & performance evaluations, conducting professional development plans as needed. Ensures that the productivity and actions of that group meet/support the overall operational goals of the department as established by department leadership.
Develops and adheres to departmental staffing, revenue and/or expense budgets. Responds to changes in the business which may affect the ability to achieve the budget goals.
Strategic Leadership of Managed Care Financial Analysis: Lead enterprise-level financial analyses of managed care contracts to assess performance, identify risks, and optimize value. Guide negotiation strategy through advanced financial modeling, scenario testing, and contract impact assessments.
Strategic Reimbursement & Pricing Analytics: Develop and oversee analytics supporting payer strategy, reimbursement methodology, and enterprise pricing decisions. Monitor market, regulatory, and payer-specific trends to inform strategic planning and maximize revenue opportunities.
Enterprise Reimbursement Analytics: Direct analysis and interpretation of reimbursement results across all service lines and payers. Deliver insights on revenue performance, denial patterns, and underpayments to drive operational and strategic action.
Advanced Financial Modeling & Forecasting: Design and maintain complex financial models projecting revenue under existing and proposed payer arrangements. Partner with Finance, Revenue Cycle, and Operations to guide margin forecasting and evaluate reimbursement scenarios.
Enterprise Collaboration & Strategic Partnership: Serve as a primary strategic partner to executive leadership, Finance, Revenue Cycle, and clinical operations. Provide subject-matter expertise on managed care economics, reimbursement dynamics, and payer performance.
Responsible for Managing Contract Management Applications (CMA) to ensure that BJC Net Revenue is accurately reflected (e.g., loading contract terms and rates into Epic)
Responsible for managing and developing Systems team's manager and employees and operations
Develop data access strategies to support contract negotiations and special projects
Partners with IT and vendors as it relates to the CMA and provides key support to Revenue Cycle Management team.
Minimum Requirements
Education
Bachelor's Degree
Finance/ComputerScience/elated
Experience
5-10 years
Supervisor Experience
2-5 years
Preferred Requirements
Education
Master's Degree
Experience
10+ years
Supervisor Experience
5-10 years
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, 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. Equal Opportunity Employer
