Director- Hospital Contract Support- Mount Sinai Health Partners

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Description

Director- Hospital Contract Support- Mount Sinai Health Partners

The Director, Hospital Contract Support manages all operational aspects of hospital managed care agreements. This includes but is not limited to, contract implementation, audits, rosters, accuracy of fee schedule linkage, and facilitation of the resolution of escalated operational and claims issues.

The Director, Hospital Contract Support is a key member of the managed care contract operations leadership team ensuring accomplishment of objectives under the direction of MSHP senior leadership.

Responsibilities

• Directly supervises, and coordinates the Hospital Contract Support team in the adherence to all operational functions and activities including operational policies and procedures, in accordance with standards established by the Third-Party Contract, Health System, institutional, governmental, and other regulatory bodies to achieve proper revenue growth and budgetary goals.
• Supports the system’s strategic mission, goals, policies and procedures, budget, work standards in coordination with system leadership.
• Develop and maintain relationships with leadership from matrix partners within MSHS.
• Develop and maintain excellent relationships with key stakeholders e.g. Finance, PFS, Appeals Management, Clinical Operations, UM / CM, Legal etc.

functioning as a managed care resource and problem solver.

• Develop and maintain effective relationships with managed care organizations (MCOs), functioning as management liaison for facility managed care issues.
• Direct, and participate in Payer joint operating committee (JOC) meetings that enable appropriate Mount Sinai and payer representatives to discuss and resolve payment and operational issues.
• Acts as a subject matter expert (SME) on facility managed care agreements and operations within the organization.
• Assures timely notification, tracking, resolution and compliance with contractual dispute resolution processes, including working with internal and external staff and legal counterparts.
• Works cross functionally with internal stakeholders to regain revenue lost / associated with contractual operational problems and contract non-compliance.
• Collaborates with PFS on revenue cycle initiatives and operational processes with a financial impact.
• Informs and educates matrix partners on new and impactful MCO coverage and claims payment policies. Works with Communications on large scale notifications.
• Directly manages complex MCO claims resolutions with significant liability, which may require escalation to legal for compliance and enforcement of contact terms.
• Aligned with managed care contracting, compliance, operations, ACO, and financial leadership in achievement of health system goals.
• Assist managed care contracting in the development of language and financial proposals to ensure the needs of the system are met.
• Works closely with Senior Medical Director, Managed Care and Billing on matters impacting revenue and system dissatisfaction.
• Develops and assists in the selection, employment, development, and management of employees and allocation of resources.
• Responsible for working on all enrollment issues related to physician, group, departmental, facility, and health system, which may impact directories, websites, claims, utilization management, or other areas where network accuracy is critical.
• Responsible for adhering to personnel policies and practices. Provides oversight of the performance appraisal process, disciplinary action, and identification of skills training.
• Ensures the development and delivery of required staff training using a competency-based assessment program. Evaluate and develop staff based on job-specific competencies.

Evaluates how staff resources are allocated to support business activities and revenue cycle initiatives.

• Handles special projects, committee assignments as assigned by the direct supervisor, VP, or SVP.
• Performs other related duties.

Qualifications

• Bachelor's Degree required, Master's degree preferred.
• 5 years experience in managed care, either in provider and MCO settings.
• 7 years preferred.

Non-Bargaining Unit, E01 - Partner MSO Services - MSH, Mount Sinai Hospital

Employer Description

Strength Through Diversity

The Mount Sinai Health System believes that diversity, equity, and inclusion are key drivers for excellence. We share a common devotion to delivering exceptional patient care.

When you join us, you become a part of Mount Sinai’s unrivaled record of achievement, education, and advancement as we revolutionize medicine together.

At Mount Sinai, our leaders strive to learn, empower others, and embrace change to further advance equity and improve the well-being of staff, patients, and the organization.

We expect our leaders to embrace anti-racism, create a collaborative and respectful environment, and constructively disrupt the status quo to improve the system and enhance care for our patients.

The Mount Sinai Health System is an equal opportunity employer. We comply with applicable Federal civil rights laws and do not discriminate, exclude, or treat people differently on the basis of race, color, national origin, age, religion, disability, sex, sexual orientation, gender identity, or gender expression.

Compensation

The Mount Sinai Health System (MSHS) provides a salary range to comply with the New York City Law on Salary Transparency in Job Advertisements.

The salary range for the role is $112827.37 - $187000 Annually. Actual salaries depend on a variety of factors, including experience, education, and hospital need.

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