The Manager, Epic Managed Care Contract Builder is a strategic reimbursement architect, subject-matter expert, and operational leader responsible for architecting, configuring, validating, and optimizing complex hospital facility payer contracts within Epic. This role drives financial performance, cash acceleration, revenue optimization and integrity in a safety net environment, ensuring the translation of negotiated managed care agreements into executable system logic, ensuring accurate reimbursement outcomes, regulatory compliance, and alignment with organizational financial strategy. This position requires deep experience in safety net hospital environments, including familiarity with Illinois Medicaid, DSH, supplemental payment programs, and complex payer structures unique to publicly funded and underserved populations. The Senior Builder serves as a strategic advisor to Managed Care, Finance, and executive leadership on reimbursement modeling, contract feasibility, and system impacts. This position reports to the Director or Executive Director of Revenue Cycle, Managed Care, or Enterprise applications.

Key Job Activities: Strategic Contract Architecture

• Leads design, builds and optimizes complex facility contracts in Epic across reimbursement methodologies (DRG, APC, case rate, percent-of-charge, per diem, carve-outs, value-based models, stop-loss, etc.).
• Translates payer contracts into executable Epic logic with financial modeling assumptions and scenario analysis.
• Provides strategic input during contract negotiations by modeling reimbursement scenarios and identifying operational risks or build contracts.
• Working with CFO, CRO and VP PHO, they quantify the financial impact of contract build decisions, including revenue lift and cash flow implications.
• Identifies and recovers revenue leakage due to contract misconfigurations.
• Works with RCM and IT teams on any hospital transparency needs.
• Leads system configuration design for new payment methodologies, pilots and alternative payment models. Advanced Testing & Validation sinaichicago.org
• Develops comprehensive test strategies using historical claims, edge-case scenarios, and complex reimbursement logic.
• Validates expected reimbursement vs. adjudicated system outcomes; identifies root causes of discrepancies.
• Establishes standardized testing frameworks and documentation protocols.
• Approves contract builds prior to production release. Safety Net Reimbursement Expertise
• Builds and validates contracts reflecting Illinois Medicaid managed care, state-directed payments, wrap payments, supplemental funding, and grant-based reimbursement structures.
• Ensures contract logic, accurately reflects regulatory and payer-specific requirements affecting safety net providers.
• Collaborates with finance and reimbursement teams on DSH, UPL, and other public payment programs as they relate to contract build and modeling. Leadership & Governance
• Serves as senior technical and strategic lead for Epic contract configuration initiatives.
• Mentors staff and junior builders; establish build standards and governance protocols.
• Leads cross-functional workgroups and initiatives involving Managed Care, Finance, Revenue Integrity, Compliance and IT.
• Ensures leadership visibility and approval of high-impact contract changes and configurations. Monitoring & Optimization
• Analyzes reimbursement variance reports to detect configuration or contract interpretation issues.
• Recommends optimization strategies to improve reimbursement accuracy and operational efficiency.
• Oversees ongoing contract maintenance, renewals, and amendments. Compliance & Audit Support
• Ensures contract builds comply with payer agreements, CMS guidance, and regulatory standards. Tests the builds and resolves discrepancies.

Maintains detailed technical documentation of contract logic, assumptions and testing results.

• Serves as organizational subject-matter expert during internal or external audits.
• Performs other duties as assigned.

Education and Work Experience:

• Bachelor’s degree in Healthcare Administration, Finance, Information Systems, or related field
• 7+ years of experience in hospital revenue cycle, managed care contracting, reimbursement modeling, or Epic applications
• Direct experience building and validating facility contracts within Epic (Resolute Hospital Billing and Contract Management required)
• Demonstrated experience working in or supporting safety net hospitals or public health systems
• Deep experience with Illinois Medicaid managed care and supplemental payment programs preferred.
• Experience with value-based reimbursement structures and risk-based contracts preferred.
• Experience supporting academic medical centers or large integrated delivery systems preferred
• Background in reimbursement analytics or revenue integrity preferred

Core Competencies:

• Strategic systems thinking sinaichicago.org
• Contract interpretation mastery
• Revenue optimization focus
• Executive-level communication
• Complex problem-solving
• Cross-functional leadership
• Regulatory and compliance fluency: Key Performance Indicators:
• Accuracy of modeling vs. adjudicated reimbursement
• Time to implement and optimize contracts
• Reduction in post-production build corrections
• Audit outcomes and compliance performance related to contract configuration
• Reduction in denial rates tied to contract logic
• Net revenue improvement from contact optimization
• Stakeholder satisfaction (Managed Care, Finance, Revenue Cycle leadership, Knowledge and Skills:
• Advanced knowledge of hospital reimbursement methodologies across government and commercial payers
• Advanced analytical, financial modeling, and systems logic skills
• Experience in EPIC and MEDITECH software systems preferred. Certifications/Licenses:
• Epic certification(s) in Resolute Hospital Billing and/or Contract Management preferred